Value of CT-guided Core Needle Biopsy in Diagnosing Spinal Lesions: A Comparison Study

Abstract

Objective: A retrospective study was designed to evaluate the effectiveness of CT-guided core needle biopsy in diagnosing spinal lesions through comparison with C-arm guidance.

Methods: From April 2013 to July 2017, a total of 188 patients, who suffered from spinal lesions or had malignant tumor history with a new spinal fracture, were included in this study. There were 96 men and 92 women, with an average of 57.1 years. A total of 238 core needle biopsies were performed. A total of 140 core needle biopsies were carried out under C-arm guidance in 102 patients (group 1); 98 core needle biopsies were carried out under CT guidance in 86 patients (group 2); 108 core needle biopsies were performed in thoracic vertebrae, 116 were in lumbar vertebrae, and 14 were in sacral vertebrae. Seventy-eight patients accepted surgical treatment after biopsies. For these patients, the histological pathologies of the biopsy and surgery were compared to evaluate the accuracy of the biopsy. For the other 110 patients who did not receive surgical treatment, the treatment response and the clinical course were used to evaluate the accuracy of the biopsy. The success rate, the diagnostic accuracy rate, the true positive/negative rate, and complications of the two groups were calculated and compared.

Results: There were no significant differences in sex, age, and lesion sites between the C-arm guidance group (group 1) and the CT guidance group (group 2). There were no complications in the two groups. Pathological diagnoses were established in 232 of 238 biopsies. They revealed that 52 were primary malignant tumors, 12 were benign tumors, 70 were metastatic tumors, 4 were tuberculosis, and 94 were classified as "other." The success rate of group 2 was higher than that of group 1, but it was not statistically significant (95.7% vs 100%; P = 0.098). According to the final diagnosis, the diagnostic accuracy rates were calculated and compared. There was no significant difference between the two groups (95.5% vs 96.9%; P = 0.835). The kappa coefficient was used to analyze the concordance between the histological pathologies of the biopsy and the final diagnosis in the two groups. The kappa values of the two group were 0.909 and 0.939, respectively. The results showed good consistency in both groups, but seemed better for group 2.

Conclusion: CT-guided core needle biopsy is a relatively safe and effective procedure for diagnosing spinal lesions with a high diagnostic accuracy rate and few complications.

Keywords: C-arm fluoroscopy guidance; CT guidance; Core needle biopsy; Diagnostic accuracy rate; Spinal lesion.

Figure 1

Images of CT‐guided biopsy. (A, B) The lesion is located in the posterior part of the vertebral body, close to the spinal canal. Biopsy confirmed metastatic low differentiation adenocarcinoma. (C, D) Transpedicular approach to an L₁ lesion, located close to the inferior endplate. Biopsy showed a plasmacytosis, but a diagnosis of tuberculosis was eventually given by a multidisciplinary team. (E, F) Biopsy was performed in the left sacroiliac joint and cytology was compatible with diffuse large B‐cell lymphoma.

Figure 2

(A) MRI showed a paravertebral soft tumor in a 61‐year‐old woman. (B) A diagnosis of schwannoma was given by CT‐guided biopsy. (C) MRI showed a soft tumor located in the intervertebral foramina in a 76‐year‐old man where it was difficult to guide by C‐arm only. (D) CT‐guided biopsy revealed it was a metastasis of renal cell carcinoma.