Zhu Yanjie, Yang Kaiqi, Wang Chuanfeng, Fan Yunshan, Wu Xinbo, He Shisheng, Gu Guangfei
Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchang Road, Shanghai, 200072, China.
Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China.
Int Orthop. 2025 Jan;49(1):203-209. doi: 10.1007/s00264-024-06361-8. Epub 2024 Nov 1.
Tissue biopsy is the gold standard for differentiating osteoporotic vertebral compression fractures from malignant lesions. However, the necessity of routine biopsies during percutaneous vertebroplasty and kyphoplasty is debated due to the low malignancy detection rates. This study aims to identify key predictors of positive biopsy outcomes in patients undergoing these procedures, with the goal of refining biopsy selection criteria to enhance diagnostic yield and improve clinical decision-making.
We conducted a retrospective cohort study involving 295 patients who underwent percutaneous vertebroplasty and kyphoplasty with biopsy between June and December 2023. Clinical data, including age, gender, fracture aetiology, imaging findings, and biopsy results, were collected. Binary logistic regression analysis was employed to identify significant predictors of positive biopsy outcomes.
The biopsy results revealed an overall malignancy rate of 1.01% (3/295). Among the 17 cases with abnormal (positive) biopsy findings, 17.6% were malignant, while the remainder were benign. Significant predictors included age (OR = 0.936), gender (OR = 0.307 for males), fracture aetiology (OR = 5.300 for fractures with no apparent cause), and imaging abnormalities (OR = 8.388).
This study underscores the low malignancy detection rate in routine biopsies for vertebral compression fractures, advocating for a more selective approach by reserving biopsies for patients with specific high-risk factors. A targeted biopsy strategy, informed by enhanced pre-operative screening, could improve diagnostic accuracy and treatment outcomes, optimizing clinical management.
组织活检是区分骨质疏松性椎体压缩骨折与恶性病变的金标准。然而，由于恶性肿瘤检出率较低，经皮椎体成形术和后凸成形术期间进行常规活检的必要性存在争议。本研究旨在确定接受这些手术的患者活检结果为阳性的关键预测因素，以完善活检选择标准，提高诊断率并改善临床决策。
我们进行了一项回顾性队列研究，纳入了295例在2023年6月至12月期间接受经皮椎体成形术和后凸成形术并进行活检的患者。收集了包括年龄、性别、骨折病因、影像学表现和活检结果在内的临床数据。采用二元逻辑回归分析来确定活检结果为阳性的显著预测因素。
活检结果显示总体恶性肿瘤率为1.01%（3/295）。在17例活检结果异常（阳性）的病例中，17.6%为恶性，其余为良性。显著预测因素包括年龄（OR = 0.936）、性别（男性OR = 0.307）、骨折病因（无明显原因的骨折OR = 5.300）和影像学异常（OR = 8.388）。
本研究强调了椎体压缩骨折常规活检中恶性肿瘤检出率较低，主张采用更具选择性的方法，为具有特定高危因素的患者保留活检。通过加强术前筛查制定的靶向活检策略可以提高诊断准确性和治疗效果，优化临床管理。
