Graham DS, Russell TA, Eckardt MA, et al. - All individuals that underwent both image-guided core-needle biopsy (IGCNBx) and surgical resection of peripheral nerve sheath tumors (PNSTs, clinically heterogeneous, comprising benign [BPNST] and malignant [MPNST] variants) between 2002 and 2016 were investigated in order to describe the efficiency and safety of IGCNBx in PNSTs. Among the 78 PNSTs with IGCNBx and postresection surgical pathology, 76% (n = 59) and 24% (n = 19) had BPNST and MPNST, respectively, on postresection surgical pathology. In 94% of cases, IGCNBx correctly ascertained malignancy. In discovering malignancy, IGCNBx illustrating schwannoma or MPNST were 100% correct. IGCNBx exhibiting neurofibroma or indeterminate outcomes were 33% and 57% malignant on postresection surgical pathology, respectively. No long-term complications, comprising sensory or motor deficiencies, from IGCNBx, were noted. In conclusion, in distinguishing benign from malignant PNSTs, percutaneous IGCNBx illustrates 94% accuracy. Moreover, due to the risk of malignant reclassification on surgical pathology, IGCNBx exhibiting neurofibroma or indeterminate pathology should be deciphered with care. Since no individual encountered long-term complications, these results reaffirm the safety of IGCNBx.