Sonographically guided fine-needle aspiration biopsy of lytic lesions of the spine: Technique and indications

Purpose. We report the use of sonography to guide fine-needle aspiration bi opsies (FNABs) of lytic lesions of the spine. Methods. Twenty-nine patients with lytic vertebral lesions with or without associated extraosseous soft-tissue extension underwent sonographically gui ded FNAB. Twelve cervical, 7 thoracic, 7 lumbar, and 3 sacral lesions were biopsied. Tissue samples were taken from either the bony lesion through a b reak in the cortex (n = 9) or the associated soft-tissue extension (n = 20) . Results. Adequate diagnostic material obtained in 27 cases (93%) revealed a n inflammatory (n = 13) or malignant process (n = 14). Of the 2 patients wi th inconclusive FNAB findings, 1 patient was lost to followup, and the othe r underwent surgery, which revealed tuberculosis. No complications of FNAB were encountered. Conclusions. We conclude that sonography is a safe and effective guidance m odality for FNAB of lytic lesions of the spine, especially for lesions in t he cervical region. In the thoracic, lumbar, and sacral regions, however, t he role of sonographically guided FNAB is limited to lesions affecting the posterior elements. (C) 1999 John Wiley & Sons, Inc.