Histological evaluation is key issue in spinal tumor surgery. Does somebody have recommendation about biopsy for metastatic spinal lesion? Practically speaking, we have to perform biopsy if we don't know primary region of tumor (or tumor histology). But if patient has oncological diagnosis in the past (he underwent radical surgical treatment, chemotherapy, etc), should we perform additional biopsy? And when should we perform spinal biopsy? I mean in what period between oncology remission and spinal lesion manifestation.
I do not know if it is correct but what we do is that when a patient with a known metastatic disease like a prostate carcinoma, comes with a lesion or more than one in the spine, we do not perform a biopsy. We consider prima facie that the lesion is due to metastasis. The same thing happens with a breast cancer. If the primary tumor does not belong to the group that frequently metastasize to bone (like HNSCC) bipsy is mandatory.
There are different cases and the approach may differ.Needle biopsy is a compromise between the answers yes and no. I prefer definitive histological diagnosis for meta static patients who are considered for surgery. This can be done intraoperatively. Unfortunately, the exact diagnosis is usually made using material taken during surgery.
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In my opinion performing a biopsy is better if there is not an emergency indication of decompression (in cases of neurological deficit due to metastatic mass and in which the condition is ongoing for less than 24 hours). Because knowing the exact histopathological diagnosis may change or help the treatment. In renal cell or thyroid carcinoma I would not prefer to perform surgery without selective arterial embolisation as they bleed a lot. Although radiology helps a lot in diagnosis, in very rare cases, the metastatic lesion may be due to another carcinoma other than that of the previously diagnosed. Or maybe it may be a primary lesion not a metastasis.
On emergency cases I would perform decompression first and obtain an open biopsy in the same session.
to Tomas Koltai
Some metastasis can manifest after long period of oncology remission. In what period should we perform biopsy for tumors with typical bone lesion?
to Yunus emre Akman
Does you perform biopsy in case of confirmed diagnosis of oncology (e.g. patient underwent surgical resection of primary tumor)?
If the remission period has been long, for example more than 3 years, a biopsy should be performed, because it may be a different tumor. But when it is a short interval, months to a year, and we know the nature of the primary tumor, I believe we can avoid the biopsy. Doing this spares the patients from further suffering and decreases the economical burden of health care.
to Tomas Koltai
Thank you for valuable comment! Can you recommend some papers which evaluate time period (e.g. 3 years in your comment)?
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