title: Computed tomography-guided percutaneous biopsy for vertebral neoplasms: a department's experience and hybrid biopsy technique to improve yield.
abstract: OBJECTIVE Recent articles have identified the poor diagnostic yield of percutaneous needle biopsy for vertebral osteomyelitis. The current study aimed to confirm the higher accuracy of CT-guided spinal biopsy for vertebral neoplasms and to identify which biopsy technique provides the highest yield. METHODS Over a 9-year period, the radiology department at University Hospitals Case Medical Center performed 222 CT-guided biopsies of vertebral lesions, of which clinicians indicated a concern for vertebral neoplasms in 122 patients. A retrospective chart review was performed to confirm the higher sensitivity of the percutaneous intervention for vertebral neoplasms. RESULTS A core sample was obtained for all 122 biopsies of concern (100.0%). Only 6 cases (4.9%) were reported as nondiagnostic per histological sampling, and 12 cases (9.8%) were negative for disease. The question of vertebral neoplastic involvement warrants follow-up, and the current study was able to determine the subsequent diagnosis of each lesion. Of the 122 total, 94 (77.0%) core samples provided true-positive results, and the sensitivity of core biopsy measured 87.9%. The technical approach did not demonstrate any significant difference in diagnostic yield. However, when the vertebral cortex was initially pierced with a coaxial bone biopsy system and subsequently a 14-gauge spring-loaded cutting biopsy needle was coaxially advanced into lytic lesions, 14 true positives were obtained with a corresponding sensitivity of 100.0%. CONCLUSIONS This study confirms the higher sensitivity of image-guided percutaneous needle biopsy for vertebral neoplasms. In addition, it demonstrates how the use of a novel cutting needle biopsy approach, performed coaxially through a core biopsy track, provides the highest yield.
authors.affiliation: Department of Radiology, University Hospitals Case Medical Center, and.
authors.forename: Vasant
authors.initials: V
authors.lastname: Garg
authors.affiliation: Department of Radiology, University Hospitals Case Medical Center, and.
authors.forename: Christos
authors.initials: C
authors.lastname: Kosmas
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Enambir S
authors.initials: ES
authors.lastname: Josan
authors.affiliation: Department of Radiology, University Hospitals Case Medical Center, and.
authors.forename: Sasan
authors.initials: S
authors.lastname: Partovi
authors.affiliation: Department of Radiology, University Hospitals Case Medical Center, and.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Bhojwani
authors.affiliation: Department of Radiology, University Hospitals Case Medical Center, and.
authors.forename: Nathan
authors.initials: N
authors.lastname: Fergus
authors.affiliation: Department of Radiology, University Hospitals Case Medical Center, and.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Young
authors.affiliation: Department of Radiology, University Hospitals Case Medical Center, and.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Robbin
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011872:Radiology Department, Hospital; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: CT-guided biopsy; FNA = fine needle aspiration; hybrid biopsy technique; vertebral neoplasms