The Value Of Cytology During Spinal Puncture

Background: examination and related examination such as MRI , it is difficult to distinguish the reason of fractures and the type of tumor ,need to rely on pathologic biopsy to diagnose finally.With the development of spinal minimally invasive treatment, without the obvious effect of percutaneous vertebroplasty and Percutaneousky phoplasty in addition to treat vertebral compressibility fracture,in the treatment of spinal tumors, and comforting, can effectively treat pain, to reinforce the vertebral bodies,also is the component of the treatment of spinal tumor.Except for the opening surgery in spinal vertebral pathologic biopsy,at present more depend on spinal biopsy,its main surgical method is the same with PVP or PKP,can be doing simultaneously,this avoids to the second trauma for patients.But multiple myeloma diagnosis should mainly rely on cytology,and the main puncture are iliac before and after,sternal and so on.Can or not use spinal biopsy puncture channels to do the cytology simultaneously for spinal lesions diagnosis,At present not see the related reports.Objective: To explore to determine the utility of cytology during spinal puncture.Methods: October 2009 - December 2010, there're 54 cases with biopsy or PVP(PKP), The male 22 cases, female 32 cases. Age 45 ~ 88 years old, average 64years old.Clinical symptoms is mainly back pain, X-ray films found that significant vertebral fracture spine bone destruction compressibility, MRI suspected spinal vertebral pathological change, the systemic bone phenomenon was found the vertebral isotopes anomalies. Preoperative routine examination did not find obviously operation contraindication .Take prone position or side-lying position, using local anesthesia and compound vein anesthesia,With mobile C-type Arm guiding,Using needles extraction vertebral bone marrow to do cytology smear and get out corresponding bone with biopsy pliers to do biopsy,conventional inspection dyeing analysis and immunohistochemistry analysis,and the observation multiple myeloma additionally , the activity on biopsy and smear cell proliferation condition and films plasma cells, Using SAS9.1 version software to analysis results,two inspections of positive group were done byχ2 test results and the rest is carried by Fisher ways with an exactly analysing method.Results: In 54 inspection cases, 3 cases not found obvious tumor-like lesions with cytology and biopsy ,47 cases found spinal tumors by biopsy 92.2%(47/51) and 44 cases found spinal tumors by cytology 86.3%(44/51), there's no any significant difference on statistically (P > 0.05). Actually, In biopsy,11 cases are primary tumor , 20 cases are metastatic tumor, 16 cases are multiple myeloma. In cytology, 9 cases are primary tumor, 17 cases are metastatic tumor and 18 cases are multiple myeloma. . There're no any significant pairwise difference on statistics(P > 0.05). The classification of metastatic tumor, In biopsy 6 cases are lung cancer metastasis, 5 cases are gastrointestinal cancer metastasis , 4 cases are breast cancer metastasis, 1 cases are prostate cancer metastasis , 1 case is failed to clearly transfer type.In cytology,4 cases are lung cancer metastasis,3 cases are gastrointestinal cancer metastasis,3 cases are breast cancer metastasis, prostate cancer metastasis in 3 cases, 4 cases failed to clearly transfer type; When taking biopsy, not remoes tissue in 2 cases, including cytology discovered1case with metastatic tumorand1 case with multiple myeloma. that few organization 1 case and no positive results 4 cases, but it has found in cytology neoplastic lesions. When the examination of cytology carried out , bone marrow smear dilution in 4 cases, failed to smear in 3 cases. In multiple myeloma examination, bone marrow hematopoietic hyperplasia at least reducing (2 +), The biopsy is complex (15/16), cytology is 61.1 percent (11/18), and both discrepancy exists remarkable significance (P < 0.05). Bone marrow hematopoietic hyperplasia active at least (3 +), biopsy is 75.0% (12/16), cytology is 50. % (9/18), and both exists remarkable significance (P < 0.05). In the results plasma cells > 20%, biopsy is 87.5% (14/16), cytology is 50% (9/18), both discrepancy exists significantly (P < 0.05).Conclusion: In diagnosis of spinal pathological change, there is value of cytology during spinal puncture, can be cooperated with the puncture biopsy complementary, especially in multiple myeloma diagnosis.