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Utility of vertebral biopsy before vertebroplasty in patients with diagnosis of vertebral compression fracture

  • Diagnostic Imaging in Oncology
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

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.

Background

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 The aim of this paper is to evaluate the frequency of unexpected positive histology in vertebral samples withdrawn from patients undergoing a vertebroplasty to evaluate if a vertebral biopsy can routinely be used in case of VCF and when a secondary cause is not suspected.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Parreira PCS, Maher CG, Megale RZ, March L, Ferreira ML (2017) An overview of clinical guidelines for the management of vertebral compression fracture: a systematic review. Spine J 17(12):1932–1938. https://doi.org/10.1016/j.spinee.2017.07.174

    Article  PubMed  Google Scholar 

  2. McCarthy J, Davis A (2016) Diagnosis and management of vertebral compression fractures. Am Fam Physician 94(1):44–50

    PubMed  Google Scholar 

  3. Office of the Surgeon General US (2004) Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville (MD): Office of the Surgeon General (US). Reports of the Surgeon General

  4. Marwick C (2000) Consensus panel considers osteoporosis. JAMA 283(16):2093–2095

    Article  CAS  Google Scholar 

  5. Mukherjee S, Thakur B, Bhagawati D, Bhagawati D, Akmal S, Arzoglou V, Yeh J, Ellamushi H (2014) Utility of routine biopsy at vertebroplasty in the management of vertebral compression fractures: a tertiary center experience. J Neurosurg Spine 21(5):687–697. https://doi.org/10.3171/2014.7.SPINE121015

    Article  PubMed  Google Scholar 

  6. Ho CS, Choi WM, Chen CY, Chen WY, Chan WP (2005) Metastasis in vertebra mimicking acute compression fractures in a patient with osteoporosis: MRI findings. Clin Imaging 29(1):64–67

    PubMed  Google Scholar 

  7. Chou KN, Lin BJ, Chien LY, Tsai WC, Ma HI, Hueng DY (2013) Simple transpedicular vertebral biopsy for diagnosis of malignancy in vertebral compression fracture. Neurol India 61(6):587–592. https://doi.org/10.4103/0028-3886.125249

    Article  PubMed  Google Scholar 

  8. Pagdal SS, Nadkarni S, Hardikar SM, Hardikar MS (2016) Role of transpedicular percutaneous vertebral biopsy for diagnosis of pathology in vertebral compression fractures. Asian Spine J 10(5):925–929

    Article  Google Scholar 

  9. Nowak S, Müller J, Schroeder HWS, Müller JU (2018) Incidence of unexpected positive histology in kyphoplasty. Eur Spine J 27(4):847–850. https://doi.org/10.1007/s00586-017-5458-z

    Article  PubMed  Google Scholar 

  10. Hansen EJ, Simony A, Carreon L, Andersen MO (2016) Rate of unsuspected malignancy in patients with vertebral compression fracture undergoing percutaneous vertebroplasty. Spine 41(6):549–552. https://doi.org/10.1097/BRS.0000000000001270

    Article  PubMed  Google Scholar 

  11. Pneumaticos SG, Chatziioannou SN, Savvidou C, Pilichou A, Rontogianni D, Korres DS (2010) Routine needle biopsy during vertebral augmentation procedures. Is it necessary? Eur Spine J 19(11):1894–1898. https://doi.org/10.1007/s00586-010-1388-8

  12. Veltri A, Bargellini I, Giorgi L, Almeida PAMS, Akhan O (2017) CIRSE Guidelines on percutaneous needle biopsy (PNB). Cardiovasc Intervent Radiol 40(10):1501–1513. https://doi.org/10.1007/s00270-017-1658-5

    Article  PubMed  Google Scholar 

  13. Old JL, Calvert M (2004) Vertebral compression fractures in the elderly. Am Fam Physician 69(1):111–116

    PubMed  Google Scholar 

  14. Melton LJ 3rd, Kan SH, Frye MA, Wahner HW, O’Fallon WM, Riggs BL (1989) Epidemiology of vertebral fractures in women. Am J Epidemiol 129(5):1000–1011

    Article  Google Scholar 

  15. An HS, Andreshak TG, Nguyen C, Williams A, Daniels D (1995) Can we distinguish between benign versus malignant compression fractures of the spine by magnetic resonance imaging? Spine 20(16):1776–1782

    Article  CAS  Google Scholar 

  16. Moulopoulos LA, Yoshimitsu K, Johnston DA, Leeds NE, Libshitz HI (1996) MR prediction of benign and malignant vertebral compression fractures. J MagnReson Imaging 6(4):667–674

    Article  CAS  Google Scholar 

  17. Rupp RE, Ebraheim NA, Coombs RJ (1995) Magnetic resonance imaging differentiation of compression spine fractures or vertebral lesions caused by osteoporosis or tumor. Spine 20(23):2499–2503 (discussion 2504)

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. SC Neuroradiologia, ASST Carlo Poma, Str. Lago Paiolo, 10, 46100, Mantova, MN, Italy

    Carlo Sozzi, Mirko Trentadue, Lisa Nicolì, Federica Tavani & Enrico Piovan

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  1. Carlo Sozzi
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  2. Mirko Trentadue
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  3. Lisa Nicolì
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  4. Federica Tavani
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  5. Enrico Piovan
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Correspondence to Carlo Sozzi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Sozzi, C., Trentadue, M., Nicolì, L. et al. Utility of vertebral biopsy before vertebroplasty in patients with diagnosis of vertebral compression fracture. Radiol med 126, 956–962 (2021). https://doi.org/10.1007/s11547-021-01353-9

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  • DOI: https://doi.org/10.1007/s11547-021-01353-9

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