Efficacy of computed tomography-guided biopsy in vertebral lesions: A prospective study

Abstract

Background: A wide variety of lesions involve spine, spectrum including vascular lesions, metabolic diseases, infections, and tumors. Magnetic resonance imaging with its multiplanar capabilities, high soft tissue, and contrast resolution plays a pivotal role in the characterization, diagnosis, and differentiation of these lesions. However, a definitive diagnosis based solely on radiological and laboratory investigations is not always possible, particularly in differentiating primary and metastatic tumors, specific and nonspecific infections, and metabolic diseases. Accurate diagnosis of spine lesions is important for its successful management. Therefore, a biopsy is generally necessary for accurate diagnosis. Materials and Methods: The present study was conducted in the Department of Orthopaedics in collaboration with the Department of Radiodiagnosis and Pathology, Pt. B. D. Sharma PGIMS, Rohtak. Eighty-seven patients of clinically and radiologically undiagnosed vertebral lesions will be underwent computed tomography scan-guided core-needle biopsy between July 2016 to May 2018. Results: Patients were of the age group from 38 to 90 years with the mean age of 56.69 ± 12.93 years with significant male preponderance. Posterolateral approach was most commonly used at dorsal and lumbar sites, whereas lateral approach was only used at sacral site. The most common approach used was posterolateral approach (51 patients), followed by transpedicular approach (33 patients), while lateral approach (3 patient) was least preferred. Transpedicular approach was found to be most accurate in our study irrespective of the spinal site ([dorsal – 83.33%], [lumbar – 100%]). Out of 87 biopsies, 66 were diagnostic and 21 were nondiagnostic (dorsal spine was the most common site to be involved). Out of 66 diagnostic cases, 18 were tuberculosis, 18 were metastasis, 9 were malignant (adenocarcinoma), and 6 were benign lesion (hemangioma), while chronic osteomyelitis, lymphoplasmocytic disorder, plasma cell dyscrasia, and nonspecific granuloma were three each. Twelve patients had the complication of local hematoma, whereas none of the patients had any kind of partial paresis and infection. Conclusion: For spinal lesions, CT guided core needle biopsy is an effective, economical, safe and minimally invasive procedure.

Keywords

• computed tomography-guided biopsy
• posterolateral approach
• vertebral lesions