Pathological Investigation of Vertebral Tumor Metastasis from Unknown Primaries - a Systematic Analysis

  • Zhang, Yan (Department of Orthopaedic Surgery, YangPu Hospital Affiliated to Tongji University) ;
  • Cai, Feng (Department of Orthopaedic Surgery, YangPu Hospital Affiliated to Tongji University) ;
  • Liu, Liang (Department of Orthopaedic Surgery, YangPu Hospital Affiliated to Tongji University) ;
  • Liu, Xiao-Dong (Department of Orthopaedic Surgery, YangPu Hospital Affiliated to Tongji University)
  • Published : 2015.03.04


Background: This systematic analysis was conducted to investigate pathological diagnosis of vertebral tumor metastasis with unknown primaries. Methods: Clinical studies conducted to pathologically investigate vertebral tumor metastasis were identified using a predefined search strategy. Pooled diagnosis (PD) of each pathological confirmation was calculated. Results: For vertebral tumor metastasis, 5 clinical studies which included 762 patients were considered eligible for inclusion. Systematic analysis suggested that, for all patients with vertebral tumor metastasis, dominant PD was pathologically confirmed with lung cancer in 21.7% (165/762), with breast cancer in 26.6% (203/762) and with prostate cancer in 19.2% (146/762). Other diagnosis that could be confirmed included lymphoma, multiple myeloma, renal cancer, for example, in this cohort of patients. Conclusions: This systemic analysis suggested that breast, lung and prostate lesions could be the most common pathological types of cancer for vertebral tumor metastasis formunknown primaries, and other common diagnoses could include lymphoma, multiple myeloma, renal cancer.


Supported by : National Natural Science Foundation of China (NSFC)


  1. Abbruzzese JL, Abbruzzese MC, Hess KR, et al (1994). Unknown primary carcinoma: natural history and prognostic factors in 657 consecutive patients. J Clin Oncol, 12, 1272-80.
  2. Al-Brahim N, Ross C, Carter B, et al (2005). The value of postmortem examination in cases of metastasis of unknown origin-20-year retrospective data from a tertiary care center. Ann Diagn Pathol, 9, 77-80.
  3. Bender CE, Berquist TH, Wold LE (1986). Imaging-assisted percutaneous biopsy of the thoracic spine. Mayo Clin Proc, 61, 942-50.
  4. Chaichana KL, Pendleton C, Wolinsky JP, et al (2009). Vertebral compression fractures in patients presenting with metastatic epidural spinal cord compression. Neurosurgery, 65, 267-74.
  5. Chang JM, Lee HJ, Goo JM, et al (2006). False positive and false negative FDG-PET scans in various thoracic diseases. Korean J Radiol, 7, 57-69.
  6. Czernin J (2002). Clinical applications of FDG-PET in oncology. Acta Med Austriaca, 29, 162 -70.
  7. Daugaard G (1994). Unknown primary tumours. Cancer Treat Rev, 20, 119-47.
  8. Destombe C, Botton E, Le Gal G, et al (2007). Investigations for bone metastasis from an unknown primary. Joint Bone Spine, 74, 85-17.
  9. Dong MJ, Lin XT, Zhao J, et al (2006). Malignant tumor with false negative 18F-FDG PET image. Zhonghua Zhong Liu Za Zhi, 28, 713-7.
  10. Fyfe IS, Henry AP, Mulholland RC (1983). Closed vertebral biopsy. J Bone Joint Surg Br, 65, 140-3.
  11. Helweg-Larsen S, Sorensen PS, Kreiner S (2000). Prognostic factors in metastatic spinal cord compression: a prospective study using multivariate analysis of variables influencing survival and gait function in 153 patients. Int J Radiat Oncol Biol Phys, 46 1163-9.
  12. Husband DJ, Grant KA, Romaniuk CS (2001). MRI in the diagnosis and treatment of suspected malignant spinal cord compression. Br J Radiol, 74, 15-23.
  13. Klekamp J, Samii H (1998). Surgical results for spinal metastases. Acta Neurochir, 140, 957-67.
  14. Laredo JD, Bard M (1986). Thoracic spine: percutaneous trephine biopsy. Radiology, 160, 485-9.
  15. Levack P, Graham J, Collie D, et al (2002). Don't wait for a sensory level-listen to the symptoms: a prospective audit of the delays in diagnosis of malignant cord compression. Clin Oncol (R Coll Radiol), 14, 472-80.
  16. Lu C, Gonzalez RG, Jolesz FA, et al (2005). Suspected spinal cord compression in cancer patients: a multidisciplinary risk assessment. J Support Oncol, 3, 305-12.
  17. Maillefert JF, Tavernier C, Tebib J (2000). Determining the site of the primary cancer in patients with skeletal metastasis of unknown origin: a retrospective study. Cancer, 88, 1759-61.<1759::AID-CNCR33>3.0.CO;2-I
  18. Mankin HJ, Lange TA, Spanier SS (1982). The hazards of biopsy in patients with malignant primary bone and soft-tissue tumors. J Bone Joint Surg Am, 64, 1121-7.
  19. Mankin HJ, Mankin CJ, Simon MA (1996). The hazards of the biopsy, revisited. Members of the Musculoskeletal Tumor Society. J Bone Joint Surg Am, 78, 656-63.
  20. Minardi AJ Jr, Sittig KM, Zibari GB, et al (1998). Colorectal cancer in the young patient. Am Surg, 64, 849-53.
  21. Muir C (1995). Cancer of unknown primary site. Cancer, 75, 353-6.<353::AID-CNCR2820751317>3.0.CO;2-P
  22. Neumann KH, Nystrom JS (1982). Metastatic cancer of unknown origin: nonsquamous cell type. Semin Oncol, 9, 427-34.
  23. Nourbakhsh A, Grady JJ, Garges KJ (2008). Percutaneous spine biopsy: a meta-analysis. J Bone Joint Surg Am, 90, 1722-5.
  24. Rose PS, Laufer I, Boland PJ, et al (2009). Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases. J Clin Oncol, 27, 5075-9.
  25. Rosenbaum SJ, Lind T, Antoch G, et al (2006). False-positive FDG PET uptake-the role of PET/CT. Eur Radiol, 16, 1054-65.
  26. Roth SE, Mousavi P, Finkelstein J, et al (2004). Metastatic burst fracture risk prediction using biomechanically based equations. Clin Orthop Relat Res, 83-90.
  27. Shah AN, Pietrobon R, Richardson WJ, et al (2003). Patterns of tumor spread and risk of fracture and epidural impingement in metastatic vertebrae. J Spinal Disord Tech, 16, 83-9.
  28. Talcott JA, Stomper PC, Drislane FW, et al (1999). Assessing suspected spinal cord compression: a multidisciplinary outcomes analysis of 342 episodes. Support Care Cancer, 7, 31-8.
  29. Taneichi H, Kaneda K, Takeda N, et al (1997). Risk factors and probability of vertebral body collapse in metastases of the thoracic and lumbar spine. Spine, 22, 239-45.
  30. Yaffe D, Greenberg G, Leitner J, et al (2003). CT-guided percutaneous biopsy of thoracic and lumbar spine: a new coaxial technique. AJNR Am J Neuroradiol, 24, 2111-3.
  31. Zhao CL, Qian GQ, Chen XY, et al (2014). Retrograde analysis of clinical characteristics of bone metastasis in 1,031 cases of preliminarily diagnosed nasopharyngeal carcinoma. Asian Pac J Cancer Prev, 15, 3785-8.