Diagnostic accuracy of preoperative imaging and intraoperative pathology in intradural spinal tumors and their impact on reoperation rate.

BACKGROUND

Accurate preoperative imaging and intraoperative pathological diagnosis are critical for managing intradural spinal tumors (IDST). This study aimed to assess the diagnostic accuracy of these methods and their impact on reoperation rates.

METHODS

A retrospective review was conducted on 1383 patients who underwent primary surgical treatment for IDST at a single institution between 2001 and 2022. Preoperative imaging diagnoses were established by spine surgeons and radiologists, while intraoperative pathological assessments were performed using frozen sections with hematoxylin and eosin staining in 929 cases. Final pathological diagnoses were confirmed through immunohistochemistry and genetic analysis. A diagnosis was defined as correct when the final pathology matched either of the two preoperative imaging diagnoses or the intraoperative frozen-section diagnosis. A discrepancy was recorded when the final pathology differed from both. Discrepancy assessments were determined retrospectively from medical records and pathology reports by a single investigator. The accuracy of preoperative imaging and intraoperative pathological diagnoses was compared with final pathology, and reoperation rates were analyzed.

RESULTS

The accuracy of preoperative imaging diagnosis was 94.2 %, while that of intraoperative pathological diagnosis was 93.6 %. In subgroup analyses of patients with intraoperative pathology, reoperation was more frequent in cases with inaccurate preoperative imaging compared with accurate imaging (7.7 % vs 2.2 %; P < 0.05). Similarly, intraoperative pathological discrepancies were associated with higher reoperation rates compared with concordant cases (10.2 % vs 2.1 %; P < 0.01).

CONCLUSIONS

This study demonstrated that both preoperative imaging and intraoperative pathology achieved high diagnostic accuracy in IDST, generally exceeding 90 %. Subgroup analyses suggested that discrepancies in preoperative imaging as well as in intraoperative pathology may be associated with an increased risk of reoperation. These findings indicate that both reliable preoperative imaging and precise intraoperative evaluation could be important for guiding surgical management, while challenges remain in diagnosing rare and histologically diverse tumors.

LEVEL OF EVIDENCE: Level III, retrospective cohort study.