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Image-guided Percutaneous Cervical Spine Biopsies: A Review of Techniques, Results, and Complication Avoidance 2012

Interventional Spine

Rebecca, Wu, M.D.
Yun, A, Tseng, D.O., Non ASSR Member
Steven, Drexler, M.D., Non ASSR Member
Orlando, Ortiz, M.D., M.B.A., F.A.C.R., Non ASSR Member

Poster

Purpose

To review a series of image-guided percutaneous cervical spine and paraspinal soft tissue biopsies with radiologic-pathologic correlation and present suggestions regarding biopsy techniques and complication avoidance.

Methods & Materials

A retrospective review of a series of image-guided percutaneous cervical spine and paraspinal soft tissue biopsies by a single operator was performed. A total of 14 cases from 2007 to the present were reviewed. Fourteen patients underwent biopsy procedures with a breakdown of 4 males and 10 females. The average ages of the patients were approximately 52 years for males and 51 years for females. All procedures were performed under CT guidance. Ten of the 14 cases were performed with an indication of evaluating for malignancy or metastatic disease and 4 were performed for a concern of infection. Pathology and/or microbiology reports were reviewed for all of the 14 cases.

Results

Of the 10 biopsies performed for evaluation of malignancy or metastatic disease, 8 were positive on pathology (80%). Of interest, one case proved to be a benign peripheral nerve sheath tumor, two were cases of multiple myeloma, and one case was a diagnosis of lymphoma. The remaining 4 cases were confirmed metastatic disease in patients with known primary malignancies. A review of the specimens obtained for the cases that were positive for malignancy demonstrates that a majority had at least one core of bone or soft tissue for analysis. Of interest in the negative cases was a patient with a history of tonsillar and laryngeal carcinoma status post radiation therapy who was referred for percutaneous biopsy of a suspicious C1 lesion that was found to be hypermetabolic on PET. Initial biopsy of the lesion revealed radiation necrosis; however, this was felt to be a spurious finding by referring clinicians. The patient was referred for a repeat biopsy of the cervical lesion and pathology again confirmed the lesion to be related to radiation necrosis rather than metastatic disease. For the 4 procedures performed with an indication of possible infection, 50% were proven to be positive based on pathology and/or microbiology results. One of the patients was known to be on antibiotics prior to the biopsy. One of the positive cases grew rare aspergillus on microbiology.

Conclusion

Though challenging, various approaches can be employed to access lesions of the cervical spine; however, the safest approach is determined by a host of factors: (1) the location of the lesion, (2) the extent of the lesion, (3) and the relationship of the lesion to adjacent critical structures. As with other image-guided percutaneous biopsy procedures, planning is paramount for a safe and successful biopsy. Use of coaxial technique both ensures that adequate sample volume can be obtained by allowing for multiple acquisitions while at the same time minimizing harm to adjacent critical structures by reducing the need for needle repositioning.

References/Financial Disclosures

1. Gupta S, Henningsen JA, Wallace MJ, Madoff DC, Morello FA, Ahrar K, Murthy R, Hicks E. Percutaneous biopsy of head and neck lesions with CT guidance: various approaches and relevant anatomic and technical considerations. RadioGraphics 2007; 27:371-390. 2. Ortiz AO, Zoarski G, Brook A. Image-guided percutaneous spine biopsy. In Mathis JM, Golovac S (eds). Image-Guided Spine Interventions. 2nd edition. New York: Springer, 2010: 75-106. 3. Sun HY, Lee JW, Kim KJ, Yeom JS, Kang HS. Percutaneous intervention of the C2 vertebral body using a CT-guided posterolateral approach. AJR Am J Roentgenol 2009; 193:1703-1705.