Type:
Educational Exhibit
Keywords:
Musculoskeletal spine, Bones, Interventional non-vascular, CT, PET-CT, MR, Biopsy, Cancer, Infection, Metastases
Authors:
A. N. Murphy1, B. Buckley2, P. J. MacMahon1, S. J. Eustace1, E. C. Kavanagh1; 1Dublin/IE, 2Galway/IE
DOI:
10.26044/ecr2019/C-2206
Background
The spine is the most common site of osseous metastatic disease; up to 70% of patients with cancer will develop bone metastases1.
This is due to the abundant red marrow in the vertebral bodies and the communication of deep veins with valve-less vertebral venous plexuses1.
Common malignancies that metastasize to the bones include: breast,
prostate,
lung and renal cell cancer1.
Image guided vertebral biopsy is a safe,
accurate and relatively inexpensive technique that can be performed in the outpatient setting under fluoroscopic or CT-guided technique.
Common indications for vertebral body biopsy include:
- A query of metastatic disease in the case of known malignancy,
- Solitary bone lesion (primary bone lesion,
plasmacytoma),
- To assess biological characteristics for targeted treatment1,
- Infection (osteomyelitis/discitis).
Accuracy and diagnostic yield:
Accuracy rate is up to 95%,
however this depends on the lesion size,
characteristics and number of samples1,2.
The diagnostic yield is increased with:
- A specimen over 1cm has a much higher diagnostic yield2,
3.
- A lytic lesion rather than a sclerotic bone lesion (87% versus 57% diagnostic yield)3.
- An increased number of specimens,
reaching a plateau at three specimens3.
There are different types of biopsy needle available.
Recently battery powered drills are being used to decrease radiation dose and procedure times,
while also significantly increasing diagnostic yield in sclerotic lesions from 55.9% to 60.0% (p=0.047) without an increase in complication rate4. Disadvantages of using a drill are the slight loss of control and sample compaction within the needle.
Complications:
Complication rate is less than 5%1,
2.
Complications depend on the level of the biopsy and include:
- Neural injury,
- Dural injury,
- Hematoma and haemorrhage,
- Adjacent organ damage,
- Tract seeding,
- Infection,
- Pneumothorax in the thoracic spine (4-11%)2.