Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Spine (Phila Pa 1976). 2009 Oct 15;34(22):2395-9. doi: 10.1097/BRS.0b013e3181b8707e.
A retrospective histologic evaluation of biopsies obtained during percutaneous vertebroplasty (PVP) procedures as treatment for presumed osteoporotic vertebral compression fractures.
To determine the rate of unsuspected malignancy in bone biopsies of patients undergoing PVP for osteoporotic vertebral compression fractures.
Most vertebral compression fractures, which result from minimal, or no trauma have osteoporosis as underlying cause. The diagnosis osteoporosis is based on clinical and radiologic findings. Even in patients with proven osteoporosis it is not always the true cause of the fractures. In literature, outcomes of bone-biopsies obtained during vertebroplasty have been described with inconsistent percentages of unexpected malignancy.
To determine the rate of unsuspected malignancy, 78 biopsies were obtained from 78 patients (18 male; 60 female; mean age, 73 years). The histologic diagnoses of vertebral body biopsy specimens were analyzed in a retrospective study.
Seventy-one biopsies (91%) obtained from 71 patients, were suitable for histologic evaluation. Seven biopsies (9.0%) could not be interpreted as a result of suboptimal quality biopsy material. The population included 10 patients (13%) with a history of malignancy, in this group no malignancy was found in the bone biopsies. In 3 patients (3.8% of all biopsies) previously undiagnosed malignancies, 2 multiple myeloma stage IIa and 1 chondrosarcoma grade I, were found.
Obtaining bone biopsies during PVPs does not lead to increased morbidity and can verify the pathologic process underlying the vertebral compression fractures. Since this study showed an unsuspected malignancy rate of 3.8%, we recommend routine obtainment of a vertebral body bone biopsy, preferably using a biopsy needle with a diameter larger than 14 Gauge (>2.1 mm/0.083 inch), during every PVP procedure.
经皮椎体成形术（PVP）治疗疑似骨质疏松性椎体压缩骨折时获取的活检组织的回顾性组织学评估。
确定在接受 PVP 治疗骨质疏松性椎体压缩骨折的患者的骨活检中未被怀疑的恶性肿瘤的发生率。
大多数由轻微或无创伤引起的椎体压缩骨折都有骨质疏松症作为潜在病因。骨质疏松症的诊断基于临床和影像学发现。即使在有明确骨质疏松症的患者中，它也不一定是骨折的真正原因。在文献中，描述了在椎体成形术中获取的骨活检的结果，其中意外恶性肿瘤的比例不一致。
为了确定未被怀疑的恶性肿瘤的发生率，对 78 例患者（18 名男性；60 名女性；平均年龄 73 岁）的 78 次活检进行了研究。对椎体活检标本的组织学诊断进行了回顾性分析。
71 例患者（91%）的 71 次活检适合进行组织学评估。7 次活检（9.0%）由于活检材料质量不佳而无法解释。该人群包括 10 例（13%）有恶性肿瘤病史的患者，在这组患者中，骨活检未发现恶性肿瘤。在 3 例（所有活检的 3.8%）患者中，发现了先前未诊断的恶性肿瘤，其中 2 例为多发性骨髓瘤 IIa 期，1 例为软骨肉瘤 I 级。
在 PVP 过程中获取骨活检不会增加发病率，并可以验证椎体压缩骨折的病理过程。由于本研究显示未被怀疑的恶性肿瘤发生率为 3.8%，因此我们建议在每次 PVP 手术中，常规使用直径大于 14 号（>2.1 毫米/0.083 英寸）的活检针获取椎体骨活检。
