I have found mixed messages in published articles around the likelihood that a primary (non-metastatic) vertebral tumor (i.e. extradural tumor) is benign.
"Metastatic tumors are most common (97%) tumors of the spine." Ciftdemir et al (2016) W J Orthopedics 7:109-116
"Primary extradural tumors of the spine are rare and constitute approximately 4% of all spine tumors." Lam et al (2014) SNI 5:S373-S375
"Benign tumors such as meningiomas and neurofibromas account for 55 to 65 percent of all primary spinal tumors... Metastatic spinal tumors are the most common type of malignant lesions of the spine, accounting for an estimated 70 percent of all spinal tumors." AANS (http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Spinal%20Tumors.aspx)
What is the truth? Do metastatic spinal tumors make up 70% or 97% of spinal tumors? What is the likelihood that a primary vertebral (extradural) tumor is benign? 20% or as little as 01.2%? This difference is far from trivial.
both in a cohort and relative to an individual the answer would depend a great deal on location and, more so, on age. do you have more details?
do you need ballpark figures for age groups, or a reference with observationally derived numbers?; the likelihood in a given case?
Thank you Andrei and Joe.
Andrei, to answer your questions this is a female patient who is in her early 40's. The location is in the anterior T4 vertebral body (attached MRI spine T2 image).
Joe, thank you for the references. Unfortunately, I've still found the same issues within the relevant literature you suggested as reading material. For instance, in the article Chasi et al (2016) bone hemangiomas are estimated as less than 1% of all primary bone neoplasms. Muhmer et al (2014) state that hemangiomas are frequent, occurring in 10-12% of the population upon autopsy. Ahlhelm et al (2006) make the same assertion. So again, we have the trouble that the literature is not consistent. Either benign spinal tumors are ~20% of spinal tumors or less than 5%. These numbers are far from consistent.
1. "Extradural" is a descriptor for lesions in the spinal canal. This is outside the spinal canal, in the vertebral body.
2. Likelihood odds and Bayesian analysis (of which I am a fan) work only that far; at some point one needs to "fish or cut bait" decisionally speaking: I.e. Do something with the probability numbers. That something, in this case, is probably a biopsy or do nothing.
3. I'd say the lesion is not a hemangioma. A subtle fracture or infection are possible. A primary tumor or the vertebra is less than 1%. A metastasis is possible but not likely .( hystory and presence or absence of lesions at other sites (bone scan) could help. Lymphoma is a distinct an important possibility because of prognostic and treatment implications.
4. This is ONLY one image, of one of the imaging studies, of a whole patient with history, clinical context, etc.; very little information for a decision.
I'd be curious what the physician ordering the MR advised. If you want to talk about it, call me in Skype or WhatsApp
Andrei Vermont
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