Percutaneous transpedicular biopsy of thoracic and lumbar vertebrae - Method and diagnostic validity

BACKGROUND Percutaneous transpedicular needle biopsy was performed on thoracic and lumbar vertebral bodies with a thin trocar (2.0 mm outer diameter) under observation with a conventional X-ray image intensifier in order to establish a correct histopathological diagnosis. We also evaluated the clinical validity of this less invasive diagnostic method in terms of the accuracy of the pathological diagnosis. METHODS Twenty-eight thoracic or lumbar vertebrae of 26 patients with abnormalities observed on routine X-ray, CT, or MRI images underwent percutaneous transpedicular needle biopsy under local anesthesia, A threaded trocar with an outer diameter of 2.0 mm was screwed into the intra-vertebral lesion through the pedicle from the posterior side under control of X-P imaging, and a small amount of tissue or fluid was collected. RESULTS For all patients but two, where inadequate specimens were obtained, correct diagnoses were made, which were confirmed by pathological diagnoses of massive tissue obtained during subsequent reconstructive surgery. CONCLUSIONS The accuracy rate of diagnosis with this biopsy method was 92% without significant intra- or postoperative complications. Therefore, it can be concluded that this less invasive biopsy method used in conjunction with conventional X-ray apparatus has good potential to result in correct preoperative diagnosis of thoracic and lumbar lesions so that more effective treatment can be determined. (C) 1999 by Elsevier Science Inc.