Increasing the specimen adequacy of transpedicular vertebral body biopsies. Role of intraoperative scrape cytology.

BACKGROUND CONTEXT

Obtaining adequate representative material has been a problem in transpedicular vertebral body biopsies resulting in inconclusive diagnosis and delayed management. By rapidly confirming the adequacy of the material intraoperatively, the rate of negative biopsies can be minimized. Present study evaluates the role of intraoperative cytology in increasing the diagnostic yield of vertebral biopsies.

PURPOSE

To evaluate the role of intraoperative cytological confirmation in increasing the specimen adequacy of vertebral biopsies.

STUDY DESIGN

A prospective cytological and histopathologic study.

PATIENT SAMPLE

Thirty-nine patients undergoing transpedicular biopsy were included.

OUTCOME MEASURES

Adequacy and accuracy along with sensitivity and specificity of transpedicular biopsies with and without adopting scrape cytological screening were analyzed.

METHODS

After obtaining transpedicular specimens, they were initially screened by intraoperative cytology before submitting for histopathologic examination. Cytological smears were prepared by rapid hematoxylin and eosin technique. Additional specimens were obtained if cytology showed inadequate or inconclusive cells.

RESULTS

Of 39 patients who underwent transpedicular biopsy, the intraoperative cytology confirmed 32 (82.1%) specimens as adequate, 5 (12.8%) inadequate, and 2 (5.1%) as inconclusive. Adequacy of biopsy specimens with intraoperative cytology was found to have a sensitivity of 96.9%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 87.5%. If the intraoperative cytology was not adopted, six of 39 (15.4%) patients would have required repeat biopsy. Of the 47 specimens from 39 lesions, 46 intraoperative cytological diagnoses correlated well with the histopathology, with an accuracy of 95.7%. The average time taken to report the adequacy was 8.9 ± 1.7 minutes.

CONCLUSIONS

Onsite intraoperative cytology is a rapid and an inexpensive technique to obtain accurate and adequate vertebral body tissue specimen with 100% diagnostic yield. The technique can be adopted easily into day-to-day practice and requires only few glass slides and regular reagents.