SC Neuroradiologia, ASST Carlo Poma, Str. Lago Paiolo, 10, 46100, Mantova, MN, Italy.
Radiol Med. 2021 Jul;126(7):956-962. doi: 10.1007/s11547-021-01353-9. Epub 2021 Apr 12.
To demonstrate the utility of a biopsy performed just before vertebroplasty in patients with diagnosis of vertebral compression fracture (VCF) and no history of neoplastic or hematologic diseases.
Osteoporosis is the most frequent cause of vertebral compression fracture, with trauma and pathologic vertebral weakening being other common causes. Since secondary fractures at imaging investigation can present as simple compression fractures, it is important to identify an underlying pathology. The aim of this paper is to evaluate the frequency of unexpected positive histology in vertebral samples withdrawn from patients undergoing a vertebroplasty to evaluate if a vertebral biopsy can routinely be used in case of VCF and when a secondary cause is not suspected.
We retrospectively evaluated the results of 324 biopsies performed from February 2003 to March 2019 just before vertebroplasty in 1183 patients diagnosed with one or more vertebral compression fractures and with no history of neoplastic or hematological diseases and with no suspicious findings for secondary fractures at imaging.
Biopsy was not diagnostic in 9/324 cases (2.8%); osteoporosis was the diagnosis in 295 cases (91%); in the remaining 20 cases (6.2%), histology was positive for an underlying pathology: 12/20 (60% of positive cases) multiple myeloma; 5/20 (25%) lymphoma/leukemia; 1/20 (5%) spondylitis; 1/20 (5%) metastasis; 1/20 (5%) hemangioma. A significantly higher incidence of positive biopsies was found in patients younger than 73 (p = 0.01) with 17 of 20 (85%) positive biopsies. No complications related to the bioptic maneuver were found, according to CIRSE guidelines on percutaneous needle biopsy.
Vertebral biopsy is a safe procedure with no related complications. In our series, an unexpected diagnosis was found in 6% of cases with impact on patient's clinical management. Positive unexpected histology was significantly higher in younger patients. In conclusion, we believe that a biopsy is useful and should be performed on all patients with vertebral compression fractures before a vertebroplasty.
展示在诊断为椎体压缩性骨折（VCF）且无肿瘤或血液病史的患者中，在椎体成形术前行活检的效用。
骨质疏松症是椎体压缩性骨折最常见的原因，创伤和病理性椎体弱化是其他常见原因。由于影像学检查中的继发性骨折可表现为单纯的压缩性骨折，因此识别潜在的病理学很重要。本文的目的是评估从接受椎体成形术的患者中取出的椎体样本中意外出现阳性组织学的频率，以确定在没有怀疑继发性骨折的情况下，椎体活检是否可以常规用于 VCF 以及何时可以使用。
我们回顾性评估了 2003 年 2 月至 2019 年 3 月期间在 1183 例诊断为 1 个或多个椎体压缩性骨折且无肿瘤或血液病史且影像学无继发性骨折可疑发现的患者中，在椎体成形术前进行的 324 例活检的结果。
在 9/324 例（2.8%）活检中无诊断意义；295 例（91%）诊断为骨质疏松症；在其余 20 例（6.2%）中，组织学为潜在病理学阳性：12/20（阳性病例的 60%）多发性骨髓瘤；5/20（25%）淋巴瘤/白血病；1/20（5%）脊椎炎；1/20（5%）转移；1/20（5%）血管瘤。在年龄小于 73 岁的患者中，阳性活检的发生率明显更高（p=0.01），20 例中有 17 例（85%）阳性活检。根据 CIRSE 关于经皮穿刺活检的指南，未发现与活检操作相关的并发症。
椎体活检是一种安全的操作，无相关并发症。在我们的系列研究中，在 6%的病例中发现了意外诊断，这对患者的临床管理产生了影响。年轻患者的意外阳性组织学明显更高。总之，我们认为在进行椎体成形术前，对所有椎体压缩性骨折患者进行活检是有用的。
