Percutaneous Spine Biopsy: A Review of the Current Literature

Percutaneous spine biopsy: reaching those hard-to-reach places

Cancer is a leading cause of death, with the spine being the most common site for skeletal metastasis. The spine is also a site for primary malignancy, such as sarcoma and chordoma, as well as non-neoplastic pathologies. An accurate diagnosis of spinal neoplastic diseases is crucial in determining appropriate management. With the advent of personalised oncology, the need to establish a definitive histopathologic diagnosis to guide management is more important than ever. Percutaneous biopsy has proven to be safe and efficient in establishing a reliable histopathologic diagnosis. The spine, however, can be a challenging site to biopsy, due to the proximity of critical neurovascular, respiratory, and gastrointestinal structures. Successful spine biopsy depends on several factors: suspected diagnosis, size of the lesion, location within the spine, modality for best imaging guidance, operator experience, technical equipment considerations, and desired approach and associated limitations. The specimen must also be obtained with a biopsy route amenable to any future surgical intervention, with surgical input often sought, frequently in a multidisciplinary setting, to confirm procedure-specific goals and expectations. Knowledge of the requisite local anatomy, procedural and patient-specific indications, and contraindications and various approaches that may be used to access different segments of the spine, potential complications, and how to address these are keys to a successful percutaneous spinal biopsy, even in the most challenging of circumstances.

A Combined Scoring Method Based on 18F-FDG PET/CT for Distinguishing Spinal Infection From Malignancy

STUDY DESIGN

Retrospective study.

OBJECTIVE

This study aimed to explore the additional value of fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for the detection of early-stage and atypical spinal infections and to find the best combination of indicators from laboratory and imaging systems for higher diagnostic efficiency.

SUMMARY OF BACKGROUND DATA

Diagnosis of early-stage and atypical spinal infections may be challenging for clinicians. It is particularly important to distinguish spinal infection from malignancy to develop a timely treatment strategy and avoid unnecessary biopsy or surgery.

MATERIALS AND METHODS

All patients with a discharge diagnosis of spinal infection or malignancy who underwent 18F-FDG PET/CT scans before spinal biopsy between January 1, 2014, and July 30, 2021, were included. Laboratory and imaging data were assessed. A receiver operating characteristic (ROC) curve was created, and the best cut-off point and cumulated area under the curve (AUC) were obtained to distinguish between spinal infection and malignancy. Kappa values were used to assess the agreement between the 18F-FDG PET/CT and MRI findings. Binary logistic regression was used to screen for statistically significant indicators and imaging findings.

RESULTS

A total of 71 patients with confirmed spinal infections (n=30) or malignancies (n=41) were included in this study. Elevated ESR and significantly elevated tumor biomarkers or positive FLCs assay were significantly different between the two groups. In addition to the total lesion glycolysis of the involved vertebral bodies derived from 18F-FDG PET/CT, four imaging findings (consecutive multilevel vertebral lesions, intervertebral disc, vertebral arch, and extraspinal involvement) also showed significant differences between the two groups (P≤0.010). A combined scoring method based on the above seven indicators was designed with an overall classification accuracy of 95.2%, and it identified all patients with spinal infections (100%, 28/28). In addition, moderate-to-excellent agreement could be reached for the involvement of intervertebral discs, paravertebral soft tissues, and vertebral arches derived from MRI and18F-FDG PET/CT.

CONCLUSIONS

The combined scoring method based on 18F-FDG PET/CT provided excellent overall accuracy in distinguishing spinal infections from malignancies. This approach may prove useful for patients with MRI contraindications or with equivocal results following laboratory tests or traditional imaging when there is high suspicion for spinal infections or malignancy.