V Juneja | PubMed Health

PubMed2000

Are L5 fractures an indicator of metastasis?

OBJECTIVE: To determine whether L5 vertebral body fractures are an indicator of malignancy. DESIGN AND PATIENTS: A retrospective study of L5 vertebral body fractures was carried out using plain radiographs, CT, and/or MRI. Over a 5-year period, 51 patients with L5 vertebral body fractures were seen at our institution. Since L1 vertebral body fractures are common, 51 age- and gender-matched (20 men, 31 women; mean age 60 years) patients with L fractures were utilized as the control group. The frequency of neoplastic infiltration of the vertebrae was compared between these two populations to determine whether pathologic fracture was more frequent at L5. RESULTS: Twelve (24%) of the L5 fractures were pathologic compared with four (8%) of the L1 fractures (chi-square test, P<0.05). Neoplasm types included multiple myeloma (n=4), prostate (n=3), breast (n=2), lung (n=2), melanoma (n=2), bladder, colon, and leukemia (each n=1). CONCLUSION: Although most L5 fractures are not pathologic, there is an increased incidence of pathologic fractures in this location compared with L1. Therefore, a fracture of L5 should raise the suspicion of metastasis.

Adolescent↗

PubMed1996

Percutaneous skeletal aspiration and core biopsy: complementary techniques.

OBJECTIVE: Although core biopsy is the standard for percutaneous bone biopsy in most other organs aspiration biopsy is frequently performed. We prospectively evaluated 138 patients with skeletal lesions, performing both core and aspiration biopsies to determine if these techniques have a complementary role. SUBJECTS AND METHODS: Over a 2-year period, 138 consecutive patients underwent skeletal biopsy. In each patient, two or three histologic cores were obtained percutaneously using standard techniques followed by a single aspiration pass with a 22-gauge spinal needle and 20 cc of negative pressure. Histologic and cytologic evaluations of cores and aspirates were interpreted according to usual pathologic and cytologic criteria. Results were classified as matches (positive or negative), mismatches (aspiration or core only positive), mismatches (either aspiration or core more specific), insufficient samples, inaccurate diagnoses, and both false-negative. RESULTS: Twenty-eight patients had specific neoplasms diagnosed on both core and aspiration biopsy, and 40 patients were negative on both. The diagnosis was made only by core in 17 and only by aspiration in 11. Core was more specific in 11, and aspiration was more specific in seven. There were three insufficient cores and 18 insufficient aspiration specimens. One false-negative result was seen by both techniques, and the cytology of two aspiration biopsies was misinterpreted. CONCLUSION: A complementary role exists for aspiration and core skeletal biopsy, and we suggest both should be routinely performed.

Biopsy↗