Introduction: This study evaluates the role of ultrasound-guided biopsy in surgical oncology in contemporary surgical practice, assessing its impact on clinical outcomes, procedural accuracy, and patient safety in a retrospective comparative analysis. Materials and Methods: A retrospective comparative study was conducted on 370 patients from June 2016 to December 2022 at a tertiary care center. Patients were divided into US-guided CNB (n=185) and Open surgical biopsy (n=185) groups. Primary outcomes included procedural success rate, complication rates, and clinical efficacy measures. Results: The US-guided CNB group demonstrated significantly improved primary outcomes compared to Open surgical biopsy (p<0.05). Complication rates were lower in the study group, and procedural efficiency was maintained or improved. Multivariate analysis confirmed the imaging modality as an independent predictor of favorable outcomes. Conclusion: The findings support the integration of advanced imaging guidance in surgical practice, demonstrating measurable improvements in accuracy, safety, and clinical outcomes that justify the investment in imaging technology.