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Michalopoulos et al present an excellent meta-analysis and systematic review including over 3900 patients undergoing almost 4200 computed tomography (CT)-guided spine biopsy procedures.1 The diagnostic yield for CT-guided spine biopsies was 91% and diagnostic accuracy per procedure was 86%. Importantly, diagnostic accuracy in cases yielding a diagnosis was 94% and the complication rate was 1%. The authors did not find a significant difference in biopsy yield between lytic, sclerotic, or mixed lesions or between biopsies performed at different spinal locations (cervical, thoracic, and lumbar). This study further adds to the literature showing CT-guided spine biopsy to be an accurate and safe procedure that radiologists with proper training should feel comfortable performing. CT-guided spine biopsy provides numerous advantages over an open procedure including decreased cost and fewer complications.2
Although the overall biopsy yield and accuracy are consistent with other results from the literature, we caution readers from reading into the results broken down by lesion imaging appearance. The analysis of results by lesion imaging appearance included only six studies and 351 biopsy procedures. Of these lesions, 301 were lytic, 21 were sclerotic, and 29 were mixed. The authors report a 100% diagnostic yield for sclerotic lesions and a 99% diagnostic yield for mixed lesions. They were not able to present diagnostic accuracy broken down by lesion imaging appearance. These results could be misleading for those performing CT-guided spine biopsy and should not lead to disappointment in the event of performing a non-diagnostic biopsy of a sclerotic lesion. …
Contributors Both authors contributed to the conception, drafting, editing, and approval of this manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.