Objective: To observe the value of C-arm cone beam CT(CBCT)-guided percutaneous core needle biopsy (PCNB) of bone neoplasms. Methods: Imaging and pathological data of 283 patients who underwent CBCT-guided PCNB of bone neoplasms were retrospectively analyzed. The success rate, incidence of complication, operation time, radiation dose,as well as diagnostic sensitivity, specificity and accuracy of CBCT-guided PCNB were calculated, and the diagnostic efficacy of CBCT-guided PCNB of bone neoplasms was analyzed based on final pathological results. Results: The success rate of CBCT-guided PCNB of bone neoplasms was 100%,with operation time of (14.10±5.95)min and radiation dose of (11.21±4.12)mSv. Among 283 patients, minor bleeding occurred in 3 (1.06%) patients, while 80 patients (28.27%) had mild pain after operation. Taken the final pathological results as standards, the sensitivity and specificity of CBCT-guided PCNB in diagnosis of benign and malignant bone tumors was 90.82% and 86.96%, respectively, with accuracy (89.81%) not statistical different from final pathological results (χ2=2.37, P>0.05). Conclusion: CBCT guigance can provide real-time fluoroscopy for accurate localization during PCNB of bone neoplasms, therefore effectively carry out preoperative planning and reduce radiation dose,being worthy of clinical promotion.