Value Of Percutaneous Coaxial Biopsy In The Destruction Of Vertebral Body Bone

OBJECTIVE To evaluate the clinical value of percutaneous coaxial transpedicular biopsy in the diagnosis of destructive lesions of vertebral body.METHOD 298 patients who had undergone percutaneous coaxial transpedicular biopsyfor 356 vertebral body destructive lesions on CT/MRI were evaluated from March,2008 to November,2016 in our institution.Among them,239 patients(279 lesions)had a history of a tumor beyond the spine,while 59 patients(77 lesions)had no history of a tumor.There were 258 patients with osteolytic destruction and 40 patients with mixed.All procedures were performed under C-arm flouroscopy guidance.Transpedicular approach was adopted in the thoracic,lumbar and sacral vertebrae.When the tip of the trocar was placed in the edge of the destructive lesions in the vertebral body,the biopsy needle was introduced coaxially through the trocar,and core biopsy samples were extracted under differently directive incisions.These samples were sent to have a pathologic examination.RESULT All procedures of coaxial transpedicular biopsy of vertebral body destructive lesions were successful.No complications were observed.There were 32 patients(10.7%)in which the tissue volume removed was insufficient to conduct histopathological diagnosis,266 patients(89.3%)with a clear pathological diagnosis and 243 patients(91.4%)with metastasis.Among 239 patients with tumor history,the pathologic evaluations were definitive in 208 patients with metastasis(87.0%),1 patient with suppurative infection,2 patients with tuberculosis and the remaining 28 patients with no diagnosis.Among 59 patients with no history of a tumor,the pathologic evaluations were definitive in 35 patients with metastasis(59.3%),12 patients with plasmacytoma(20.3%),2 patients with aggressive hemangioma(3.4%),3 patients with tuberculosis(5.1%),3 patients(5.1%)with suppurative infection and the remaining 4 patients with no diagnosis.The positive diagnosis rate of osteolytic and mixed lesions were respectively 91.5%(236/258)and 75.0%(30/40),there was significant difference between them(P<0.05).The detective rates of vertebral metastasis in the patients with a history of a tumor and the patients without a tumor history were repctivly 87.3%(208/239)and 59.3%(35/59),there was significant difference between them(P<0.05).CONCLUSION Percutaneous coaxial biopsy is a safe and useful procedure for the histological evaluation of vertebral body destructive lesions,can be perform with high diagnostic yield in both osteolytic and mixed vertebral destruction.