SAN FRANCISCO — Patients not suspected of having cancer in the spine or thought to be in remission were readily identified through routine vertebral bone biopsy performed during vertebroplasty to treat a vertebral compression fractures, according to a study presented at the American Association of Neurological Surgeons Annual Meeting.
Soumya Mukherjee, a neurosurgical trainee in the Department of Neurosurgery at St. George Hospital, in London, and colleagues found their combined rate for diagnosing cancer in patients without known cancer or in remission was 5.7% based on 184 biopsy samples taken during vertebroplasties. They performed a prospective observational study to evaluate the results of both procedures performed in 135 patients treated between April 2006 and March 2011 at their institution.
“In aggregate, 22% of patients had a malignant vertebral compression fracture (VCF). Actually two-thirds were multiple myeloma,” Mukherjee said, here.
The mean age of the patients studied was 61 years and there was an equal number of men and women. The technique for the vertebroplasty technique involved the use of polymethylmethacrylate bone cement and the biopsy technique involved use of a 2-mm bone biopsy needle.
“Forty-two percent of patients had no evidence of malignancy on bone biopsy so they had an osteoporotic VCF,” Mukherjee said.
The biopsy was inconclusive in 28% of the patients, he noted. Among patients without cancer at the time of VCF, a biopsy revealed four cases of new malignancies and yielded a 4.7% rate of new cancer diagnosis in that group of patients. Those patients received an oncology referral.
The vertebroplasty procedure, in all of these cases, was associated with improvements in disability based on the Oswestry Disability Index scores and in pain measured with the VAS pain scores.
“Our data have shown that routine biopsy at the time of vertebroplasty provided an early diagnosis of cancer or relapse disease in previously unsuspected patients…. We also recommend that we biopsy every level in the case of multilevel VCFs,” Mukherjee said. – by Susan M. Rapp
Mukherjee S. Paper #621. Presented at: American Association of Neurological Surgeons Annual Meeting; April 5-9, 2014; San Francisco.
Disclosure: Mukherjee has no relevant financial disclosures.