Diagnostic Efficacy and Clinical Impact of Image-guided Core Needle Biopsy of Suspected Adult Nonvertebral Osteomyelitis

TL;DR

This study shows that image-guided biopsies for bone infections help diagnose osteomyelitis in over half of cases and change treatment in about a quarter of patients.

Contribution

The study provides large-scale evidence on the diagnostic and clinical utility of image-guided core needle biopsies for nonvertebral osteomyelitis.

Findings

Histopathology diagnosed osteomyelitis in 51.6% of biopsies.

28.7% of biopsies had positive microbiological cultures.

Biopsies changed clinical management in 26.2% of cases.

Abstract

The diagnostic yield and clinical impact of image-guided core needle biopsy (ICNB) of suspected nonvertebral osteomyelitis in adults is heterogenous in published studies because of small sample size, indicating the need for large cohort studies.

A retrospective analysis of ICNBs was performed from 2010 to 2021 for patients with suspected nonvertebral osteomyelitis. For each biopsy, a series of factors were analyzed, as well as if histopathology was diagnostic of osteomyelitis and if microbiological cultures were positive. Additionally, it was recorded in what way biopsy influenced clinical management regarding antimicrobial treatment. Multivariate statistical analysis was performed to evaluate the factors associated with yield.

A total of 883 biopsies performed on 787 patients were included. A histopathologic diagnosis of osteomyelitis was made in 51.6% (381/738) of biopsies, and microbiological cultures were positive in 28.7% (253/883) of biopsies. Antimicrobial exposure before biopsy was negatively associated with positive cultures from bone core samples (odds ratio [OR] = 0.52; 95% confidence interval [CI], .33–.83; P = .0005). Elevated hemoglobin A1c (continuous variable) (OR = 1.38; 95% CI, 1.03–1.86; P = .03), and purulent aspirate (OR = 28.1; 95% CI, 2.67–1.86; P = .03) were positively associated with positive cultures from aspirate samples. Clinical management was affected by ICNB in 26.2% (231/883) of cases.

In this large cohort, ICNB yielded approximately 30% positive cultures and changed clinical management in more than one fourth of patients.

In a retrospective study of 883 image-guided biopsies of suspected nonvertebral osteomyelitis, microbiological cultures were positive in 28.7% (253/883) of biopsies, a histopathologic diagnosis of osteomyelitis was made in 51.6% (197/381), and 26.2% (231/883) of biopsies affected clinical management.

Figures