Efficiency and Safety of Percutaneous Spinal Biopsy Using Forceps

Objective: Percutaneous spinal biopsy is an important tool in the detection and evaluation of patients with metastatic tumors, primary tumors, and infectious spondylitis. It has been reported that in lesions resistant to tissue-tearing, an accurate diagnosis via percutaneous needle biopsy is difficult. A few studies have performed spinal biopsy using forceps, which are mainly used for gastrointestinal endoscopy and transbronchial biopsy. The purpose of this study was to demonstrate the safety and efficiency of performing bone biopsies using forceps.Methods: This multicenter retrospective study included patients who underwent fluoroscopy-guided spinal bone biopsy from July 2013 to November 2020 for suspected spondylitis, tumor metastasis, and primary tumors based on spinal imaging. Data on patients’ demographic characteristics were collected from their electronic medical records. Procedure-related factors such as instrument type, diagnostic yield, procedure time, and the presence of specific lesions (necrotic, sclerosing, or cystic lesions) on preoperative imaging were investigated. Pain at the pathology site was checked using a visual analogue scale before and 1 day after the procedure. We divided the participants into two groups based on the instrument (flyer forceps or biopsy needle) used during the biopsy and analyzed each factor between the two groups.Results: A total of 30 patients (aged 12-81 years) underwent spinal biopsy using a biopsy needle (n=16) or flyer forceps (n=14). Spinal biopsy was performed on 20 patients with metastatic tumors, three with sarcoma, and nine with infections. There were no demographic differences between the two groups, and no difference in pain intensity before and after the procedure was observed between the two groups. The operation time was significantly shorter in the flyer forceps group than in the conventional biopsy needle group (p=0.02). The accuracy of the diagnostic yield of the biopsy was higher in the flyer forceps group (100%) than in the biopsy needle group (75%), and the difference was statistically significant (p=0.04). Conclusion: This study demonstrates the usefulness and safety of bone biopsies performed using flyer forceps. The use of flyer forceps in fluoroscopy-guided biopsy enables the effective collection of sufficient samples in a shorter time than conventional biopsy needles. Furthermore, this procedure enabled more accurate diagnoses.