Biopsy and Staging of Sacral Tumors

Abstract

Tumors arising within the sacrum are rare and often present a diagnostic challenge. The etiology of the tumor is the primary consideration at the time of presentation so as to direct therapy appropriately. Initial imaging such as plain radiographs or computed tomography (CT) often suggests a primary sacral neoplasm (Fig. 6.1). Magnetic resonance imaging (MRI) can be used to stratify the lesion as benign or malignant (Fig. 6.2). In the latter category, a history of previous malignancy will help to delineate between a primary or metastatic lesion. Since metastatic lesions are far more common in the sacrum than primary malignancies, a thorough history is a critical component of the diagnostic decision-making. Following this thorough history, a biopsy is indicated to confirm diagnostic suspicion from the initial imaging. Once a diagnosis is confirmed on biopsy, staging studies are required to complete the management plan and define optimal modes of therapy. This chapter will review the differential diagnosis, the optimal biopsy method, and the staging studies required for optimal management of sacral tumors.