Percutaneous CT-Guided Biopsy of Osseous Lesion of the Spine in Patients with Known or Suspected Malignancy
Eric Lisa,
Mark H. Bilskyb,
Leszek Pisinskid,
Patrick Bolandc,
John H. Healeyc,
Bernie O’Malleye and
George Krola
a Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
b Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, NY
c Department of Orthopedics, Memorial Sloan-Kettering Cancer Center, New York, NY
d Department of Radiology, Harlem Hospital, New York, NY
e Department of Radiology, Princeton Medical Center, NJ
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FIG 1. Axial CT images of midthoracic lesions.
A, Image obtained in a patient with no known cancer shows the planned angle, entry point, depth to the most posterior part of the cortex, and depth to the lesion. Biopsy revealed adenocarcinoma, probably originating from the lung.
B, Image obtained in a patient with a history of breast cancer shows radiopaque skin markers in place to determine the entry point. Biopsy confirmed suspected metastatic breast cancer.
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FIG 2. Axial CT images from biopsy of a L3 collapse deformity revealing metastatic non–small cell lung carcinoma. Left, Image through the 25-gauge anesthetic needle used to anesthetize the skin and subcutaneous soft tissues. Middle, Image shows the 21-gauge vanSonneberg one-step access needle (Cook) allowing anesthetization of the deep paraspinal soft tissues and adjacent periosteum. Right, Image shows a 15-gauge Ostycut needle (C. R. Bard, Covington, GA) in good position and ready to be advanced through the adjacent cortex.
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FIG 3. Axial CT image shows the larger-bore Ostycut needle (C. R. Bard) providing a tunnel through the posterior cortex of L2 and allowing the narrower 18-gauge, thin-walled, cutting needle to be advanced coaxially into the lytic lesion in this patient with a history of colon cancer. Biopsy showed adenocarcinoma consistent with a colonic origin.
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FIG 4. Axial CT images. A, Transpedicular approach to a T6 lytic lesion in a patient without a prior cancer history. Cytologic and histologic findings revealed numerous plasma cells compatible with plasma cell neoplasm-plasmacytoma.
B, Transcostovertebral approach to a T8 lytic lesion in a patient with a history papillary thyroid cancer. Biopsy confirmed metastatic thyroid cancer.
C, Paraspinal approach to a mixed L3 lytic-sclerotic lesion in a patient with breast cancer. Biopsy showed adenocarcinoma consistent with a mammary origin.
D, Anterolateral approach to a C5 lytic lesion in a patient with a history of gastric cancer. Cytology was compatible with metastatic gastric carcinoma.
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FIG 5. Lateral scout and axial CT images through C2 show a transoropharyngeal approach to a lesion in the body of C2 in a patient without a history of cancer but who was first stabilized posteriorly. Arrow shows the needle tip in the C2 lytic lesion. Biopsy showed squamous cell carcinoma, possibly from the lung or upper aerodigestive tract. The primary site was never determined.
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