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Holistic Approach to the Diagnosis and Treatment of Patients with Tumor Metastases to the Spine. Cancers (Basel) 2022; 14:cancers14143480. [PMID: 35884541 PMCID: PMC9317366 DOI: 10.3390/cancers14143480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/10/2022] [Accepted: 07/15/2022] [Indexed: 01/04/2023] Open
Abstract
The treatment of neoplastic spine metastases requires multi-faceted assessment and an interdisciplinary approach to patients. The metastases do not show specific symptoms but are often the first confirmation of the presence of a primary tumor in a patient. The diagnostic process includes imaging and invasive procedures, e.g., biopsy. It is essential to qualify the patient for an appropriate treatment using dedicated scales. Decompression of the spinal cord is a critical issue to save or restore neurological function in a patient with spine metastases. Surgical treatment ought to meet three criteria: release spinal cord and nerve roots, restore the spine’s anatomical relations, and ensure the internal stabilization of the spine. A good result from surgical treatment enables the continuation of radiotherapy, chemotherapy, hormone therapy, and targeted molecular therapy. Stereotactic radiosurgery and stereotactic body radiotherapy are more effective ways of treating spine metastases than conventional external beam radiotherapy. They allow higher doses of radiation, concentrated precisely at the tumor site. Our review summarizes the established and emerging concepts in the treatment of spine metastases. A holistic approach to the patient enables the selection of the appropriate therapy.
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Koepke LG, Heuer A, Stangenberg M, Dreimann M, Welker L, Bokemeyer C, Strahl A, Asemissen AM, Viezens L. Surgical Site Cytology to Diagnose Spinal Lesions. Diagnostics (Basel) 2022; 12:diagnostics12020310. [PMID: 35204401 PMCID: PMC8871040 DOI: 10.3390/diagnostics12020310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/26/2022] Open
Abstract
Patients with new-onset malignant spinal lesions often have an urgent need for local spine intervention and systemic therapy. For optimal management, it is crucial to diagnose the underlying disease as quickly and reliably as possible. The aim of our current study was to determine the feasibility, sensitivity, specificity, and diagnostic certainty of complementary cytological evaluation of spinal lesions suspected of malignancy. In 44 patients, we performed histopathological biopsies and in parallel cytologic preparations from the malignant site. Cytological smears were prepared and stained for May-Grunwald and Giemsa. Bone biopsies were histopathologically analyzed according to the existing standard-of-care practices. In 42 of 44 cases (95%), a cytological sample was successfully obtained. In 40 cases (95.2%, Cohen’s kappa: 0.77), the cytological diagnosis agreed with the histological diagnosis regarding the identification of a malignant lesion. This resulted in a sensitivity of 97% and a specificity of 80% as well as a diagnostic safety of 95%. Cytological analysis in the context of spinal surgery proved sufficient to establish a diagnosis of malignancy or its exclusion, expanding the existing diagnostic spectrum. Furthermore, implementation of this process as a routine clinical diagnostic might shorten the time to diagnosis and improve the treatment of this vulnerable patient group.
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Affiliation(s)
- Leon-Gordian Koepke
- Department of Trauma and Orthopedic Surgery, Division of Spine Surgery, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany; (A.H.); (M.S.); (M.D.); (L.V.)
- Correspondence: ; Tel.: +49-17632605843
| | - Annika Heuer
- Department of Trauma and Orthopedic Surgery, Division of Spine Surgery, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany; (A.H.); (M.S.); (M.D.); (L.V.)
| | - Martin Stangenberg
- Department of Trauma and Orthopedic Surgery, Division of Spine Surgery, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany; (A.H.); (M.S.); (M.D.); (L.V.)
| | - Marc Dreimann
- Department of Trauma and Orthopedic Surgery, Division of Spine Surgery, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany; (A.H.); (M.S.); (M.D.); (L.V.)
| | - Lutz Welker
- Institute of Pathology with the Sections Molecular Pathology and Cytopathology, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany;
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald University Cancer Center, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany; (C.B.); (A.M.A.)
| | - André Strahl
- Department of Trauma and Orthopedic Surgery, Division of Orthopedics, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany;
| | - Anne Marie Asemissen
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald University Cancer Center, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany; (C.B.); (A.M.A.)
| | - Lennart Viezens
- Department of Trauma and Orthopedic Surgery, Division of Spine Surgery, University Medical Center Hamburg Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany; (A.H.); (M.S.); (M.D.); (L.V.)
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