A variety of tests exist to help diagnose metastatic spinal tumors, including a physical exam, blood tests and imaging. A physical examination will include a thorough patient history and a review of patient physical and neurological symptoms. Typically, a biopsy is required to make a final diagnosis.
Metastatic Spine Tumor Imaging
Several imaging modalities are used to evaluate patients with spinal tumors. Images are used to determine tumor locations and size.
When a spinal fracture is suspected an X-ray may be used to identify and evaluate the fracture. However, because X-rays can only image bones and not soft tissue such as a new tumor growth, additional imaging using computed tomography (CT) or magnetic resonance imaging (MRI) is often part of the process.
Computed Tomography (CT scan)
CT is often replacing X-ray for first-line imaging, as it clearly differentiates bone from soft tissue (such as a tumor). A CT scan uses special X-ray equipment and computer software to enhance images.
Magnetic Resonance Imaging (MRI scan)
MRI is the most sensitive imaging modality for visualizing spine tumors. It provides accurate information about the soft tissues and bony structures of the spine using magnetic field and pulses of radio wave energy to create images. Because of the magnetic energy, if patients have certain types of metal implants or other devices (such as a pacemaker), they cannot have an MRI and are prescribed a CT scan instead.
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Metastatic Spinal Tumor Biopsy
A biopsy involves extracting a tissue sample from the tumor so that it can be examined by a pathologist. In most cases, percutaneous needle biopsy is used, meaning that the needle in inserted through the skin and it is not an open surgical procedure. The results of the biopsy are used to help determine which treatment is best for each patient.
Percutaneous Needle Biopsy
A needle is inserted into the tumor through the skin. When conducted with X-ray guided imaging, accuracy is almost 90%.6 Recovery time after a biopsy is short and patients can quickly resume normal activities.
Open Incisional and Excisional Biopsy
Both procedures are considered open surgery and are usually reserved for when another surgery is already planned, such as removal of the tumor. Open biopsy is not generally performed on metastatic spinal tumor patients.
- Laufer I et al. Surgical Management of Metastatic Spinal Tumors. Cancer Control 2012;19(2):122-128.