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

Wednesday, March 8, 2023

4:03 PM – 4:12 PM

Location: Phoenix Convention Center, 221AB

Presenting Author(s)

Winston Winkler, B.S.

Medical Student
Mallinckrodt Institute of Radiology

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

GD

Gino Detorre, M.Res

Medical Student
Mallinckrodt Institute of Radiology
Jack Jennings, MD PHD

Professor
Washington University/Mallinckrodt Institute of Radiology

Disclosure(s):

Winston Winkler, B.S.: No financial relationships to disclose

Jack Jennings, MD PHD: agnovos: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing); Bard: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing); Boston Scientific: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing); Merit: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing); stryker: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing); Varian: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing), Speaking and Teaching (Ongoing)

Purpose: To provide an accurate estimate of the diagnostic yield of image-guided core needle biopsy (ICNB) of suspected osteomyelitis in adults, evaluate what factors are associated with yield and determine the clinical impact of ICNB.

Materials and Methods: A retrospective analysis of ICNBs was performed from 2010-2021 for clinically suspected 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 if and in what way the biopsy influenced clinical management in regard to antimicrobial treatment. Multivariate statistical analysis was performed to evaluate the factors associated with yield.

Results: A total of 1461 biopsies performed on 1322 patients (mean age,57.0 years±15.3.0[standard deviation];842 men) were included. Microbiological cultures were positive in 25.1%(366/1461) of biopsies and a histopathologic diagnosis of osteomyelitis was made in 58.7%(739/1258). Lesion location in the vertebrae was positively associated with histopathology diagnostic of osteomyelitis (OR=2.3,95%CI(1.6-3.4),p< 0.001) and positive microbiological cultures from aspirate samples (OR=1.9,95%CI(1.01-3.4),p=0.045). Elevated erythrocyte sedimentation rate (OR=2.1,95%CI(1.03-4.2),p=0.04), positive blood cultures (OR=2.1,95%CI(1.2-3.8),p=0.008) and history of fever two weeks prior to biopsy (OR=1.6,95%CI(1.02-2.5) p=0.04) were positively associated with positive microbiological cultures from bone core samples, while antimicrobial exposure (OR=0.5,95%CI(0.3-0.8),p=0.002) and a histopathologic diagnosis of chronic osteomyelitis (OR=0.5,95%CI(0.3-0.8),p=0.002) were negatively associated. Clinical management was affected by ICNB in 31.1%(454/1461) of cases.

Conclusion: ICNB yields 25% positive cultures and changes clinical management in up to one third of patients. Several factors are associated with positive microbiological results.