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Oka M, Suzuki A, Terai H, Kato M, Toyoda H, Takahashi S, Tamai K, Nakamura H. Factors Predicting the Final Diagnosis in Image-Guided Percutaneous Needle Biopsy for Suspected Spinal Tumors. J Clin Med 2023; 12:4292. [PMID: 37445327 DOI: 10.3390/jcm12134292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
In cases of suspected spinal tumors on imaging studies, a biopsy is often necessary for establishing the diagnosis. Predictive factors for tumors or malignancies may help in scheduling biopsies or avoiding unnecessary ones. However, there have been few studies on determining these factors. We aimed to determine the factors associated with the final diagnosis in cases requiring spinal biopsy. This study included 117 patients who underwent image-guided (fluoroscopy- or computed tomography [CT]-guided) needle biopsy of the spine. Data on patient demographic, pathological diagnoses, and final diagnoses were retrospectively collected from the medical records. The imaging features and location of lesions were also evaluated on CT and magnetic resonance imaging. Furthermore, factors related to tumors or malignancies were analyzed. The diagnostic accuracy of biopsy was 94.0%, and there was no difference in the diagnostic accuracy between the fluoroscopic and CT-guided biopsies. Sixty-six and fifty-six patients were diagnosed with spinal tumors and malignant tumors, respectively. Multivariate analysis revealed that a history of malignant tumors and the presence of pedicle lesions and/or extravertebral lesions were related factors for both tumors or malignancy in the final diagnosis. These findings can help determine the necessity for or timing of biopsy in patients with suspected spinal tumors.
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Affiliation(s)
- Makoto Oka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka 545-8585, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka 545-8585, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka 545-8585, Japan
| | - Minori Kato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka 545-8585, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka 545-8585, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka 545-8585, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka 545-8585, Japan
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Ferreira FBMD, Puchnick A, Garcia DL, Regacini R, Perez P, Rosa Pinto MB, Guimaraes JB, Fernandes ADRC. Image-Guided Percutaneous Needle Biopsy for Benign and Malignant Bone Tumors: Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2022; 34:623-632.e2. [PMID: 36587804 DOI: 10.1016/j.jvir.2022.12.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/21/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To compare the diagnostic yield and accuracy of both image-guided core-needle biopsy (CNB) and fine-needle biopsy and evaluate the benefit of performing fine-needle biopsy in addition to CNB in patients with suspected benign and malignant bone tumors. MATERIALS AND METHODS A systematic search was performed on March 10, 2021, to determine whether fine-needle aspiration (FNA) plays any role when performed alone or in combination with CNB. The included studies were aggregated for the pooled estimates of diagnostic yield and histologic accuracy of image-guided percutaneous needle biopsy of bone tumors. Twenty-nine studies published between 1996 and 2021 were included. RESULTS When all patients with bone tumors were included, the rates of diagnostic yield and accuracy of FNA and CNB were 88.5% and 82.5% and 91.4% and 92.7%, respectively; the rates of both the methods combined were 96.5% and 94.1%, respectively; and for the lytic subgroup, the rates of diagnostic yield and accuracy of CNB and both the methods combined were 94.3% and 100% and 98.9% and 90.4%, respectively. A P value of <.05 was considered statistically significant. CONCLUSION The present meta-analysis showed that core biopsy alone outperformed fine-needle biopsy alone in all categories of benign and malignant tumors. Additionally, the diagnostic yield was improved when FNA was used in addition to CNB for lytic bone lesions.
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Affiliation(s)
| | - Andrea Puchnick
- Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil
| | - Diego Lessa Garcia
- Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil
| | - Rodrigo Regacini
- Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil
| | - Paulo Perez
- Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil
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Krishnan A, Marathe N, Degulmadi D, Mayi S, Rai RR, Bali SK, Parmar V, Amin P, Dave M, Dave BR. Transpedicular vertebral biopsy under O-arm navigation: a technical note. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00165-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Despite emerging techniques, sample inadequacy remains the most important factor that necessitates need for repeat biopsy. Transpedicular Biopsy has diagnostic accuracy ranging from 75 to 90% in both computed tomography guided or percutaneous C-arm guided biopsy. Presenting in this article is an add on technique as a modification to enhance quality and quantity of sample obtained using a self designed trocar cannula with computed tomography-based Navigation.
Main body
We have used transpedicular biopsy technique under C Arm fluoroscopy, previously, where we used a self-designed trocar and cannula in our study of 71 cases & reported an accuracy of 88.7% with no reported complications. This is add on modification of same technique where under 3D navigation, we introduce a pituitary forceps through a correctly positioned cannula. This helps for biopsy of soft lesions/ discal level pathologies. Also, multi-planar adjustment of cannula after initial Stealth O-Arm navigation helps in sampling of different regions of vertebral body by reinsertion of pituitary forceps with simple manipulation of cannula without withdrawal. This minimizes risk of fracturing pedicle. With our technical modification, cannulated drill bit with core opening can be drilled through cannula to retrieve a sample. Our technique has limitations being experience driven and also enabling technology dependent. However, same method can be applied using 2-dimensional fluoroscopy without navigation.
Conclusion
Our technique of using pituitary forceps through cannula is highly effective in getting adequate representative sample with spectrum ranging from hard sclerotic lesions to soft lesions and discal pathologies. This procedure can be used with traditional 2-dimensional fluoroscopy as well as with 3-dimensional navigated precision.
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Koepke LG, Heuer A, Stangenberg M, Dreimann M, Welker L, Bokemeyer C, Strahl A, Asemissen AM, Viezens L. Surgical Site Cytology to Diagnose Spinal Lesions. Diagnostics (Basel) 2022; 12:diagnostics12020310. [PMID: 35204401 PMCID: PMC8871040 DOI: 10.3390/diagnostics12020310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/26/2022] Open
Abstract
Patients with new-onset malignant spinal lesions often have an urgent need for local spine intervention and systemic therapy. For optimal management, it is crucial to diagnose the underlying disease as quickly and reliably as possible. The aim of our current study was to determine the feasibility, sensitivity, specificity, and diagnostic certainty of complementary cytological evaluation of spinal lesions suspected of malignancy. In 44 patients, we performed histopathological biopsies and in parallel cytologic preparations from the malignant site. Cytological smears were prepared and stained for May-Grunwald and Giemsa. Bone biopsies were histopathologically analyzed according to the existing standard-of-care practices. In 42 of 44 cases (95%), a cytological sample was successfully obtained. In 40 cases (95.2%, Cohen’s kappa: 0.77), the cytological diagnosis agreed with the histological diagnosis regarding the identification of a malignant lesion. This resulted in a sensitivity of 97% and a specificity of 80% as well as a diagnostic safety of 95%. Cytological analysis in the context of spinal surgery proved sufficient to establish a diagnosis of malignancy or its exclusion, expanding the existing diagnostic spectrum. Furthermore, implementation of this process as a routine clinical diagnostic might shorten the time to diagnosis and improve the treatment of this vulnerable patient group.
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Affiliation(s)
- Leon-Gordian Koepke
- Department of Trauma and Orthopedic Surgery, Division of Spine Surgery, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany; (A.H.); (M.S.); (M.D.); (L.V.)
- Correspondence: ; Tel.: +49-17632605843
| | - Annika Heuer
- Department of Trauma and Orthopedic Surgery, Division of Spine Surgery, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany; (A.H.); (M.S.); (M.D.); (L.V.)
| | - Martin Stangenberg
- Department of Trauma and Orthopedic Surgery, Division of Spine Surgery, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany; (A.H.); (M.S.); (M.D.); (L.V.)
| | - Marc Dreimann
- Department of Trauma and Orthopedic Surgery, Division of Spine Surgery, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany; (A.H.); (M.S.); (M.D.); (L.V.)
| | - Lutz Welker
- Institute of Pathology with the Sections Molecular Pathology and Cytopathology, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany;
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald University Cancer Center, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany; (C.B.); (A.M.A.)
| | - André Strahl
- Department of Trauma and Orthopedic Surgery, Division of Orthopedics, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany;
| | - Anne Marie Asemissen
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald University Cancer Center, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany; (C.B.); (A.M.A.)
| | - Lennart Viezens
- Department of Trauma and Orthopedic Surgery, Division of Spine Surgery, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany; (A.H.); (M.S.); (M.D.); (L.V.)
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Percutaneous Spine Biopsy: A Review of the Current Literature. J Am Acad Orthop Surg 2021; 29:e681-e692. [PMID: 33591122 DOI: 10.5435/jaaos-d-20-00100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 01/01/2021] [Indexed: 02/07/2023] Open
Abstract
Spine lesions are often the result of pathologic processes elsewhere in the body; prompt and accurate diagnosis are crucial to optimize treatment. Despite modern advances in imaging modalities, definitive diagnosis ultimately requires biopsy and histologic analysis. Although open surgical biopsy has traditionally been considered the benchmark, percutaneous image-guided needle biopsy of the spine has proven to be a safe and highly effective method in making a diagnosis. Choosing the optimal biopsy approach, instrumentation and modality of image guidance may depend on a number of factors including lesion type, location, and level within the spine. Knowledge of relevant anatomy, indications, contraindications, and potential complications are critical to a successful biopsy procedure.
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Michalopoulos GD, Yolcu YU, Ghaith AK, Alvi MA, Carr CM, Bydon M. Diagnostic yield, accuracy, and complication rate of CT-guided biopsy for spinal lesions: a systematic review and meta-analysis. J Neurointerv Surg 2021; 13:841-847. [PMID: 33883210 DOI: 10.1136/neurintsurg-2021-017419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND CT-guided biopsy is a commonly used diagnostic procedure for spinal lesions. This meta-analysis aims to investigate its diagnostic performance and complications, as well as factors influencing outcomes. METHODS A systematic review of the literature was performed to identify studies reporting outcomes of CT-guided biopsies for spinal lesions. Diagnostic yield (ie, the rate of procedures resulting in a specific pathological diagnosis) and diagnostic accuracy (ie, the rate of procedures resulting in the correct diagnosis) were the primary outcomes of interest. Complications following biopsy procedures were also included. RESULTS Thirty-nine studies with 3917 patients undergoing 4181 procedures were included. Diagnostic yield per procedure was 91% (95% CI 88% to 94%) among 3598 procedures. The most common reason for non-diagnostic biopsies was inadequacy of sample. No difference in diagnostic yield between different locations and between lytic, sclerotic, and mixed lesions was found. Diagnostic yield did not differ between procedures using ≤13G and ≥14G needles. Diagnostic accuracy per procedure was 86% (95% CI 82% to 89%) among 3054 procedures. Diagnostic accuracy among 2426 procedures that yielded a diagnosis was 94% (95% CI 92% to 96%). Complication rate was 1% (95% CI 0.4% to 1.9%) among 3357 procedures. Transient pain and minor hematoma were the most common complications encountered. CONCLUSION In our meta-analysis of 39 studies reporting diagnostic performance and complications of CT-guided biopsy, we found a diagnostic yield of 91% and diagnostic accuracy of 86% with a complication rate of 1%. Diagnostic yield did not differ between different locations, between lytic, sclerotic and mixed lesions, and between wide- and thin-bore needles.
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Affiliation(s)
- Giorgos D Michalopoulos
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Yagiz Ugur Yolcu
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdul Karim Ghaith
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammed Ali Alvi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA .,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
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Percutaneous C-Arm Free O-Arm Navigated Biopsy for Spinal Pathologies: A Technical Note. Diagnostics (Basel) 2021; 11:diagnostics11040636. [PMID: 33915927 PMCID: PMC8065997 DOI: 10.3390/diagnostics11040636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Percutaneous biopsy under computed tomography (CT) guidance is a standard technique to obtain a definitive diagnosis when spinal tumors, metastases or infections are suspected. However, specimens obtained using a needle are sometimes inadequate for correct diagnosis. This report describes a unique biopsy technique which is C-arm free O-arm navigated using microforceps. This has not been previously described as a biopsy procedure. CASE DESCRIPTION A 74-year-old man with T1 vertebra pathology was referred to our hospital with muscle weakness of the right hand, clumsiness and cervicothoracic pain. CT-guided biopsy was performed, but histopathological diagnosis could not be obtained due to insufficient tissue. The patient then underwent biopsy under O-arm navigation, so we could obtain sufficient tissue and small cell carcinoma was diagnosed on histopathological examination. A patient later received chemotherapy and radiation. CONCLUSIONS C-arm free O-arm navigated biopsy is an effective technique for obtaining sufficient material from spine pathologies. Tissue from an exact pathological site can be obtained with 3-D images. This new O-arm navigation biopsy may provide an alternative to repeat CT-guided or open biopsy.
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8
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Review article: the current status of CT-guided needle biopsy of the spine. Skeletal Radiol 2021; 50:281-299. [PMID: 32815040 DOI: 10.1007/s00256-020-03584-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023]
Abstract
CT-guided percutaneous needle biopsy of the spine is a well-described technique for determining the nature of indeterminate vertebral lesions or establishing a diagnosis of spinal infection, the high diagnostic accuracy and the safety of the procedure having been extensively documented. The purpose of the current article is to review the literature to date on CT-guided spinal biopsy. Specifically, indications for spinal biopsy, techniques for optimising yield, detail of the approaches for various spinal levels which is dependent upon both the region within the spinal column and lesion location within the vertebra (body vs. neural arch), determinants of biopsy outcome and complications are covered. It is hoped that the review will be of particular benefit to junior radiologists who are required to perform this procedure.
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Guenette JP, Cho CH, Huang RY, Miskin N, Ghazikhanian V, Lee TC. CT-Guided Percutaneous Spine Biopsy Specimen Adequacy, Pathology Concordance, and Negative Predictive Value with Battery-Powered Drill and Manual Approaches. Curr Probl Diagn Radiol 2019; 48:558-562. [DOI: 10.1067/j.cpradiol.2018.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 11/22/2022]
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Burke MC, Garg A, Youngner JM, Deshmukh SD, Omar IM. Initial experience with dual-energy computed tomography-guided bone biopsies of bone lesions that are occult on monoenergetic CT. Skeletal Radiol 2019; 48:605-613. [PMID: 30343440 DOI: 10.1007/s00256-018-3087-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Our purpose was to determine whether dual-energy CT (DECT), specifically the bone marrow setting of the virtual noncalcium (VNCa) algorithm, could be used to identify and accurately biopsy suspected bone malignancies that were visible on magnetic resonance imaging (MRI), nuclear bone scintigraphy, or positron-emission tomography/computed tomography (PET/CT), but occult on monoenergetic computed tomography (CT) by virtue of being either isodense or nearly isodense to surrounding normal bone. MATERIALS AND METHODS We present 4 cases in which DECT was used to detect various malignant bone lesions and was successfully used to direct percutaneous DECT-guided bone biopsies. RESULTS Two of the lesions were solid tumor metastases (breast and prostate carcinoma), whereas two others were hematological malignancies (leukemia and lymphoma). This technique enabled us to confidently and accurately direct the biopsy needle into the target lesion. CONCLUSION The authors demonstrate that the DECT VNCa bone marrow algorithm may be helpful in identifying isodense bone lesions of various histologies and may be used to guide percutaneous bone biopsies. This technique may help to maximize diagnostic yield, minimize the number of passes into the region of concern, and prevent patients from undergoing repeat biopsy.
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Affiliation(s)
- Michael C Burke
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA.
| | - Ankur Garg
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
| | - Jonathan M Youngner
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
| | - Swati D Deshmukh
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
| | - Imran M Omar
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
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Liang Y, Liu P, Jiang LB, Wang HL, Hu AN, Zhou XG, Li XL, Lin H, Wu D, Dong J. Value of CT-guided Core Needle Biopsy in Diagnosing Spinal Lesions: A Comparison Study. Orthop Surg 2019; 11:60-65. [PMID: 30767427 PMCID: PMC6430454 DOI: 10.1111/os.12418] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE A retrospective study was designed to evaluate the effectiveness of CT-guided core needle biopsy in diagnosing spinal lesions through comparison with C-arm guidance. METHODS From April 2013 to July 2017, a total of 188 patients, who suffered from spinal lesions or had malignant tumor history with a new spinal fracture, were included in this study. There were 96 men and 92 women, with an average of 57.1 years. A total of 238 core needle biopsies were performed. A total of 140 core needle biopsies were carried out under C-arm guidance in 102 patients (group 1); 98 core needle biopsies were carried out under CT guidance in 86 patients (group 2); 108 core needle biopsies were performed in thoracic vertebrae, 116 were in lumbar vertebrae, and 14 were in sacral vertebrae. Seventy-eight patients accepted surgical treatment after biopsies. For these patients, the histological pathologies of the biopsy and surgery were compared to evaluate the accuracy of the biopsy. For the other 110 patients who did not receive surgical treatment, the treatment response and the clinical course were used to evaluate the accuracy of the biopsy. The success rate, the diagnostic accuracy rate, the true positive/negative rate, and complications of the two groups were calculated and compared. RESULTS There were no significant differences in sex, age, and lesion sites between the C-arm guidance group (group 1) and the CT guidance group (group 2). There were no complications in the two groups. Pathological diagnoses were established in 232 of 238 biopsies. They revealed that 52 were primary malignant tumors, 12 were benign tumors, 70 were metastatic tumors, 4 were tuberculosis, and 94 were classified as "other." The success rate of group 2 was higher than that of group 1, but it was not statistically significant (95.7% vs 100%; P = 0.098). According to the final diagnosis, the diagnostic accuracy rates were calculated and compared. There was no significant difference between the two groups (95.5% vs 96.9%; P = 0.835). The kappa coefficient was used to analyze the concordance between the histological pathologies of the biopsy and the final diagnosis in the two groups. The kappa values of the two group were 0.909 and 0.939, respectively. The results showed good consistency in both groups, but seemed better for group 2. CONCLUSION CT-guided core needle biopsy is a relatively safe and effective procedure for diagnosing spinal lesions with a high diagnostic accuracy rate and few complications.
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Affiliation(s)
- Yun Liang
- Department of Orthopaedics, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
| | - Peng Liu
- Department of Orthopaedics, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li-Bo Jiang
- Department of Orthopaedics, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hou-Lei Wang
- Department of Orthopaedics, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
| | - An-Nan Hu
- Department of Orthopaedics, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao-Gang Zhou
- Department of Orthopaedics, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xi-Lei Li
- Department of Orthopaedics, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Lin
- Department of Orthopaedics, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dong Wu
- Department of Radiology, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Dong
- Department of Orthopaedics, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
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Feroz I, Makhdoomi RH, Khursheed N, Shaheen F, Shah P. Utility of Computed Tomography-guided Biopsy in Evaluation of Metastatic Spinal Lesions. Asian J Neurosurg 2018; 13:577-584. [PMID: 30283508 PMCID: PMC6159094 DOI: 10.4103/ajns.ajns_192_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Computed tomography (CT)-guided biopsy of spine is currently a valuable diagnostic tool and effective technique for diagnosing and planning a proper therapeutic strategy for certain spinal lesions. The reported diagnostic accuracy of core biopsy ranges from 77% to 97%. MATERIALS AND METHODS We included all patients with spinal lesions suspicious of metastasis on magnetic resonance imaging, who presented between May 2012 and April 2014 and underwent CT-guided biopsy in our study. A total of thirty patients with spinal lesions were evaluated. RESULTS Majority presented in the seventh decade of their life (average age = 53.93; age range = 10-72 years). Male:female ratio was 1.5:1. Pain was the most common presenting symptom (100%). Lumbar spine was the most common site of lesion followed by dorsal spine. Biopsy is the gold standard in histopathological evaluation of spinal lesions. Metastatic lesion was diagnosed in 12 (40%) cases, plasmacytoma in 12 (40%) cases, non-Hodgkin's lymphoma in 2 (6.66%) cases, small round cell tumor in 1 (3.33%) case, nonspecific chronic inflammation in two patients, and necrosis with no viable cells in one patient. The most common malignancy to metastasize to spine was adenocarcinoma. The most common primary tumor of spine was plasmacytoma - multiple myeloma. CONCLUSION CCT-guided biopsy is a safe procedure, and no procedure-related complication was seen in any patient.
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Affiliation(s)
- Imza Feroz
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Rumana Hamid Makhdoomi
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Nayil Khursheed
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Feroze Shaheen
- Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Parveen Shah
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Wiesner EL, Hillen TJ, Long J, Jennings JW. Percutaneous CT-Guided Biopsies of the Cervical Spine: Technique, Histopathologic and Microbiologic Yield, and Safety at a Single Academic Institution. AJNR Am J Neuroradiol 2018; 39:981-985. [PMID: 29650783 DOI: 10.3174/ajnr.a5603] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 01/24/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Cervical spine biopsies can be challenging due to the anatomy and the adjacent critical structures. Percutaneous image-guided biopsies can obviate the need for an open biopsy, however there have been few studies looking at the approaches, safety, and efficacy of percutaneous cervical spine biopsies. This retrospective study evaluated technical considerations, histopathologic and microbiologic yield, and safety in CT-guided cervical bone biopsies. MATERIALS AND METHODS A retrospective review of cervical bone and/or bone/disc biopsies performed from January 2010 to January 2017 was included in this study. Clinical diagnosis and indication, patient demographics, biopsy location, biopsy needle type, technical approach, lesion size, dose-length product, conscious sedation details, complications, and diagnostic histopathologic and/or microbiologic yield were recorded for each case and summarized. RESULTS A total of 73 patients underwent CT-guided cervical bone biopsies. Fifty-three percent (39/73) were for clinical/imaging concern for infection and 47% (34/73) were for primary tumors or metastatic disease. Thirty-four percent (25/73) were of the inferior cervical spine (ie, C6 and C7). A sufficient sample was obtained for histopathologic and microbiologic analyses in 96% (70/73) of the biopsies. Forty-six percent (18/39) of those samples taken for infection had positive cultures. Two intraprocedural complications occurred in which the patients became hypotensive during the procedure without long-term complications. CONCLUSIONS Percutaneous CT-guided biopsy of the cervical spine is an effective and safe procedure with high diagnostic yield and can obviate open procedures for histopathologic and microbiologic analyses of patients with clinical and imaging findings concerning for infection or primary and metastatic osseous lesions.
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Affiliation(s)
- E L Wiesner
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
| | - T J Hillen
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - J Long
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - J W Jennings
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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14
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Kapetanakis S, Chourmouzi D, Gkasdaris G, Katsaridis V, Eleftheriadis E, Givissis P. Functional extra-adrenal paraganglioma of the retroperitoneum giving thoracolumbar spine metastases after a five-year disease-free follow-up: a rare malignant condition with challenging management. Pan Afr Med J 2017; 28:94. [PMID: 29255564 PMCID: PMC5724945 DOI: 10.11604/pamj.2017.28.94.13783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 09/12/2017] [Indexed: 11/11/2022] Open
Abstract
Paragangliomas are benign neoplasms that arise from the autonomic nervous system and the associated paraganglia. Although benign, they have been shown to possess metastatic potential. Extra-adrenal retroperitoneal paraganglioma with vertebral metastasis is considered very uncommon. Here, we present a case of a functional extra-adrenal paraganglioma of the retroperitoneum giving metastasis to T4 vertebra after five years of follow-up in a 48-year-old man who had been initially treated with complete resection of the primary tumor. The condition of the patient improved significantly after radiosurgery and somatostatin analogs treatment, until lumbar spine lesions appeared six months later. Our case demonstrates that retroperitoneal paraganglioma is a rare condition which should be considered in the differential diagnosis of a retroperitoneal mass combined with vertebral lesions. Additionally, increased physician awareness and long-term follow-up is mandatory for all patients with history of retroperitoneal paraganglioma since metastases may occur after long latent intervals from the initial diagnosis.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Danai Chourmouzi
- Radiology Department, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Grigorios Gkasdaris
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Vasileios Katsaridis
- Neurosurgery Department, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | - Panagiotis Givissis
- First Orthopaedic Department of 'Aristotle University of Thessaloniki', 'Papanikolaou' Hospital, Exohi, Thessaloniki, Greece
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15
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Patil SS, Mohite S, Varma R, Bhojraj SY, Nene AM. Non-surgical management of cord compression in tuberculosis: a series of surprises. Asian Spine J 2014; 8:315-21. [PMID: 24967045 PMCID: PMC4068851 DOI: 10.4184/asj.2014.8.3.315] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/17/2013] [Accepted: 07/23/2013] [Indexed: 11/30/2022] Open
Abstract
STUDY DESIGN Prospective study. PURPOSE We present a series of 50 patients with tuberculous cord compression who were offered systematic non-surgical treatment, and thereby, the author proposes that clinico-radiological soft tissue cord compression is not an emergency indication for surgery. OVERVIEW OF LITERATURE Spinal cord compression whether clinical or radiological has usually been believed to be an indication for emergency surgery in spinal tuberculosis. METHODS Fifty adults were prospectively studied at our clinic for spinal cord compression due to tuberculous spondylitis, between May 1993 and July 2002. The inclusion criteria were cases with clinical and/or radiological evidence of cord compression (documented soft tissue effacement of the cord with complete obliteration of the thecal sac at that level on magnetic resonance imaging scan). Exclusion criteria were lesions below the conus level, presence of bony compression, severe or progressive neurological deficit ( RESULTS At the time of presentation, 10 patients had a motor deficit, 18 had clinically detectable hyper-reflexia and 22 had normal neurology. Forty-seven of the 50 patients responded completely to non-operative treatment and healed with no residual neurological deficit. Three patients with progressive neurological deficit while on treatment were operated on with eventual excellent recovery. CONCLUSIONS Radiological evidence of cord compression and early neurological signs need not be an emergency surgical indication in the management of spinal tuberculosis.
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Affiliation(s)
- Sanganagouda Shivanagouda Patil
- Division of Spine Surgery, Department of Orthopaedics, PD Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Sheetal Mohite
- Division of Spine Surgery, Department of Orthopaedics, PD Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Raghuprasad Varma
- Division of Spine Surgery, Department of Orthopaedics, PD Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Shekhar Y Bhojraj
- Division of Spine Surgery, Department of Orthopaedics, PD Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Abhay Madhusudan Nene
- Division of Spine Surgery, Department of Orthopaedics, PD Hinduja National Hospital and Medical Research Centre, Mumbai, India
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16
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Abstract
STUDY DESIGN Eight cases of fibrous dysplasia (FD) of the mobile spine treated surgically at the same center were retrospectively reviewed. OBJECTIVE The study focuses on the issues concerning the diagnosis of FD and the outcome of conventional surgical techniques (resection or curettage) and vertebroplasty in the treatment of spinal FD lesions. SUMMARY OF BACKGROUND DATA Surgical excision or curettage is considered the standard treatment of spinal FD, whereas vertebroplasty is also performed occasionally. METHODS Between January 2005 and October 2010, 8 consecutive patients with spinal FD underwent conventional surgery (6 cases) or combined with vertebroplasty (2 cases). Before surgery, 4 patients underwent percutaneous computed tomography-guided biopsy, whereas 3 had incorrect histopathological diagnosis. In each of the 8 cases, the final pathological diagnosis was established after their open surgery. RESULTS Pain relief was observed postoperatively in all patients. Three patients with neurological impairment became symptom-free after surgery. No cement extravasation was observed. Screw loosening and allograft resorption were observed in 1 case each. Signs of radiological improvement (filling of lytic lesions or thickening of the bone cortex surrounding the lesions) were not detected in any case. CONCLUSION The radiological features of spinal FD may be atypical. The rate of correct preoperative pathological diagnosis by computed tomography-guided biopsy was low for patients with suspected spinal FD. Vertebroplasty is probably a valuable therapeutic option for spinal FD with pathological fractures. Limited decompression and stability with vertebroplasty might be recommended for patients with neurological deficits.
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