16th German Spine Congress Annual Meeting of the German Spine Society 9th to 11th December 2021 Muenster, Germany

Introduction: Patients (pt) with disseminated tumor disease often suffer from spinal lesions. Not infrequently, complaints triggered by these lesions are the initial symptom of a previously unknown tumor disease. In addition to spinal surgical care, confirming the diagnosis is crucial for further diagnostic and therapeutic procedures. Histopathological confirmation of the diagnosis is considered the gold standard and can take up to 14 days (d). Supplementary intralesional aspiration cytology (IAZ) can significantly shorten the time to diagnosis.
Material/Method: During the initial surgical treatment of newly diagnosed malignant spinal lesions, IAZ is performed in parallel with histopathological specimen collection. Intraoperative aspiration of bone marrow from the vertebral body is performed via a transpedicular approach using a Jamshidi needle. The cytologic specimens are stained according to May-Gruenwald- Giemsa and evaluated by light microscopy. Routine histopathologic diagnosis is performed in parallel.
Results: To date, 19 pt (12 male and 7 female) with suspected initial manifestation of spinal malignant lesions have been studied. The median age was 60 years (y) (range 47- y). Multiple myeloma was diagnosed in 6 pt and solid neoplasia in 12 pt breast carcinoma (Ca), 2 prostate Ca, 2 bronchial Ca, 1 hepatocellular Ca, 1 malignant melanoma, 1 renal cell Ca). One pt showed no evidence of malignancy. The median time to confirmation of the cytologic diagnosis was 1 d (range 0- d) and d (range - (p < 0.01) to confirmation of the histopathologic diagnosis. In 2 pt, with cytologic evidence of adenocarcinoma and highly elevated prostate-specific antigen in serum, specific systemic treatment with bicalutamide could be initiated before confirmation of the final histologic diagnosis. In both cases, histopathologic examination confirmed the diagnosis of prostate carcinoma. Congruence between histology and IAZ was 100% with respect to detection of malignant cells and differentiation between hematologic or solid neoplasia.
Discussion: IAZ from malignant spinal lesions can be safely performed during spinal surgery and significantly shortens the time to confirm or narrow down the diagnosis of previously unknown tumor disease (p < 0.01). The high concordance between cytologic and histopathologic classification allows prompt planning of further diagnosis and therapy, therefore serves to ensure the safety of pt and has the potential to optimize the prognosis of the underlying disease by early initiation of systemic therapy. IAZ from spinal lesions suspected of malignancy should be performed in addition to histopathology and should become part of clinical routine.