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Original research
Diagnostic yield, accuracy, and complication rate of CT-guided biopsy for spinal lesions: a systematic review and meta-analysis
  1. Giorgos D Michalopoulos1,2,
  2. Yagiz Ugur Yolcu1,2,
  3. Abdul Karim Ghaith1,2,
  4. Mohammed Ali Alvi1,2,
  5. Carrie M Carr3,
  6. Mohamad Bydon1,2
  1. 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Radiology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Mohamad Bydon, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; bydon.mohamad{at}mayo.edu

Abstract

Background CT-guided biopsy is a commonly used diagnostic procedure for spinal lesions. This meta-analysis aims to investigate its diagnostic performance and complications, as well as factors influencing outcomes.

Methods A systematic review of the literature was performed to identify studies reporting outcomes of CT-guided biopsies for spinal lesions. Diagnostic yield (ie, the rate of procedures resulting in a specific pathological diagnosis) and diagnostic accuracy (ie, the rate of procedures resulting in the correct diagnosis) were the primary outcomes of interest. Complications following biopsy procedures were also included.

Results Thirty-nine studies with 3917 patients undergoing 4181 procedures were included. Diagnostic yield per procedure was 91% (95% CI 88% to 94%) among 3598 procedures. The most common reason for non-diagnostic biopsies was inadequacy of sample. No difference in diagnostic yield between different locations and between lytic, sclerotic, and mixed lesions was found. Diagnostic yield did not differ between procedures using ≤13G and ≥14G needles. Diagnostic accuracy per procedure was 86% (95% CI 82% to 89%) among 3054 procedures. Diagnostic accuracy among 2426 procedures that yielded a diagnosis was 94% (95% CI 92% to 96%). Complication rate was 1% (95% CI 0.4% to 1.9%) among 3357 procedures. Transient pain and minor hematoma were the most common complications encountered.

Conclusion In our meta-analysis of 39 studies reporting diagnostic performance and complications of CT-guided biopsy, we found a diagnostic yield of 91% and diagnostic accuracy of 86% with a complication rate of 1%. Diagnostic yield did not differ between different locations, between lytic, sclerotic and mixed lesions, and between wide- and thin-bore needles.

  • spine
  • CT
  • lesion
  • neoplasm
  • infection

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. The current manuscript is a systematic review and meta-analysis of already published studies. We have included references to all the studies we have obtained data from.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. The current manuscript is a systematic review and meta-analysis of already published studies. We have included references to all the studies we have obtained data from.

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Footnotes

  • Twitter @_Giorgos_M_, @yagizyolcu, @abdul_ghaith

  • Contributors GDM: Planning, statistical analysis, manuscript writing, guarantor. YUY: Planning, statistical analysis, manuscript writing. AKG: Data extraction, manuscript writing. MAA: data extraction, statistical analysis. CMC: Research interpretation, manuscript editing. MB: Research interpretation, manuscript writing, guarantor.

  • 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; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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