Percutaneous CT-guided biopsy of the spine: results of 430 biopsies

Abstract

Biopsies of lesions in the spine are often challenging procedures with significant risk of complications. CT-guided needle biopsies could lower these risks but uncertainties still exist about the diagnostic accuracy. Aim of this retrospective study was to evaluate the diagnostic accuracy of CT-guided needle biopsies for bone lesions of the spine. We retrieved the results of 430 core needle biopsies carried out over the past fifteen years at the authors' institute and examined the results obtained. Of the 430 biopsies performed, in 401 cases the right diagnosis was made with the first CT-guided needle biopsy (93.3% accuracy rate). Highest accuracy rates were obtained in primary and secondary malignant lesions. Most false negative results were found in cervical lesions and in benign, pseudotumoral, inflammatory, and systemic pathologies. There were only 9 complications (5 transient paresis, 4 haematomas that resolved spontaneously) that had no influence on the treatment strategy, nor on the patient's outcome. In conclusion we can assert that this technique is reliable and safe and should be considered the gold standard in biopsies of the spine.

Radiation Dose Reduction in CT-Guided Spine Biopsies Does Not Reduce Diagnostic Yield

“…In particular, CT guidance has been used for biopsy of a variety of sites within the body. [1][2][3][4]8,15,16,[20][21][22][23] This is largely attributed to an improved ability of the operator to identify the lesion and plan a trajectory for biopsy. CT-guided biopsy has been shown to be an effective tool in identifying pathology with relatively low risk and cost compared with open biopsy.…”

“…CT-guided biopsy has been shown to be an effective tool in identifying pathology with relatively low risk and cost compared with open biopsy. 4,22,24 However, a frequently cited concern with CT scanning is the potential consequences of ionizing radiation, and there is much emphasis on limiting radiation to as low as reasonably achievable to obtain the necessary results whenever possible. 8,25 Previous studies have demonstrated the utility of a low-dose CT technique for a variety of interventional procedures.…”

“…CT guidance is the preferred method of biopsy for osseous lesions within the vertebrae. [1][2][3][4] Even though CT guidance has become increasingly used for various procedures, there is concern over the amount of radiation exposure to the patient. [5][6][7][8] Radiation dose reduction is commonly used in routine diagnostic CT scanning.…”

Percutaneous approach to the upper thoracic spine: optimal patient positioning

“…More recently, trans-pedicular and trans-costovertebral approaches have been described [1,[3][4][5][6]9]. CT guidance has been described as safer than fluoroscopic guidance [10]; however, a recent meta-analysis has suggested no significant difference in complication rates (3.3-5.3%) [7].…”

CT-guided Biopsy for Musculoskeletal Lesions

“…However, because of the increased risks of infection, wound healing problems, hematoma formation, pathological fractures, and tumor contamination of healthy tissues, open biopsy should be performed only if a previously attempted percutaneous biopsy has been nondiagnostic. [1][2][3] In addition, excisional biopsy should be performed only for superficial, small (3 cm or less) lesions that can be excised with clear margins. 3 Moreover, in spinal and deep-seated pelvic lesions, an open biopsy can be a difficult procedure and has a significant risk of tumor spread and tissue contamination.…”