Malignant spinal lesions (MSLs) are frequently the first manifestation of malignant disease. Spinal care, diagnostic evaluation, and the initiation of systemic therapy are crucial for outcomes in patients (pts) with advanced cancer. However, histopathology (HP) may be time consuming. The additional evaluation of spinal lesions using cytopathology (CP) has the potential to reduce the time to diagnosis (TTD) and time to therapy (TTT). CP and HP specimens from spinal lesions were evaluated in parallel in 61 pts (CP/HP group). Furthermore, 139 pts in whom only HP was performed were analyzed (HP group). We analyzed the TTD of CP and HP within the CP/HP group. Furthermore, we compared the TTD and TTT between the groups. The mean TTD in CP was 1.7 ± 1.7 days (d) and 8.4 ± 3.6 d in HP (p< 0.001). In 13 pts in the CP/HP group (24.1%), specific therapy was initiated based on the CP findings in combination with imaging and biomarker results before completion of HP. The mean TTT in the CP/HP group was 21.0 ± 15.8 d and was significantly shorter compared to the HP group (28.6 ± 23.3 d) (p= 0.034). Concurrent CP for MSLs significantly reduces the TTD and TTT. As a result, incorporating concurrent CP for analyzing spinal lesions suspected of malignancy might have the potential to enhance pts’ quality of life and prognosis in advanced cancer. Therefore, we recommend implementing CP as a standard procedure for the evaluation of MSLs.
恶性脊柱病变常为恶性疾病的首发表现。脊柱护理、诊断评估及全身治疗的启动对晚期癌症患者的预后至关重要。然而组织病理学检查可能耗时较长。通过细胞病理学对脊柱病变进行补充评估，有望缩短诊断时间和治疗启动时间。本研究对61例患者（CP/HP组）的脊柱病变标本同时进行细胞病理学和组织病理学评估，并另分析139例仅接受组织病理学检查的患者（HP组）。我们分析了CP/HP组内细胞病理学和组织病理学的诊断时间，并比较了两组间的诊断时间与治疗启动时间。细胞病理学平均诊断时间为1.7±1.7天，组织病理学为8.4±3.6天（p<0.001）。在CP/HP组中，13例患者（24.1%）在组织病理学完成前，已根据细胞病理学结果结合影像学及生物标志物检查启动了特异性治疗。CP/HP组平均治疗启动时间为21.0±15.8天，显著短于HP组的28.6±23.3天（p=0.034）。同步开展细胞病理学检查可显著缩短恶性脊柱病变的诊断时间和治疗启动时间。因此，对疑似恶性脊柱病变联合采用细胞病理学分析，可能有助于改善晚期癌症患者的生活质量和预后。我们建议将细胞病理学作为恶性脊柱病变评估的标准流程。
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