The role of intraoperative scrape cytology in vertebroplasty.
OBJECTIVE
To assess the adequacy of intraoperative scrape cytology during percutaneous vertebroplasty by correlating results with corresponding histopathology.


METHODS
Vertebroplasty is a procedure increasingly used to treat painful vertebral compression fractures. The history and presentation of osteoporotic fractures are straightforward, but difficulty arises in differentiating infective from neoplastic lesions, especially in cases where the magnetic resonance imaging is equivocal. The procedure involves injection of polymethyl methacrylate (bone cement) into the pathological vertebral body and gives dramatic pain relief. It is indicated in osteoporotic and neoplastic lesions but contraindicated in infections. Hence, intraoperative evaluation of a specimen is essential to aid in the decision of performing vertebroplasty.


METHODS
A total of 128 patients with vertebral lesions underwent core biopsy and scrape cytology from June 2006 to June 2015. Based on the findings of cytological examination, malignant lesions were subjected to vertebroplasty. In lesions with infective etiology, vertebroplasty was abandoned and antibiotic or antituberculous therapy started.


RESULTS
The overall diagnostic accuracy of scrape cytology was excellent with 97.58% cases correlating with the final histopathological diagnosis. Specificity was 100%, positive predictive value was 100% and negative predictive value was 33.33%.


CONCLUSIONS
Scrape cytology is a simple, rapid, accurate cytodiagnostic technique and should be routinely utilized in vertebral lesions for intraoperative consultation and decision making during vertebroplasty.
Address: Department of Pathology and Orthopedics, NRI Medical College, Guntur, Andhra Pradesh, India.
Renuka Venkata
RV
Inuganti
Address: Department of Pathology and Orthopedics, NRI Medical College, Guntur, Andhra Pradesh, India.
Rami Reddy
RR
Mettu
Address: Department of Pathology and Orthopedics, NRI Medical College, Guntur, Andhra Pradesh, India.
Harsha Vardhan
HV
Surath
Address: Department of Pathology and Orthopedics, NRI Medical College, Guntur, Andhra Pradesh, India.
Amarnath
A
Surath
Cytodiagnosis; intraoperative procedures; vertebrae; vertebroplasty