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CT-guided discitis-osteomyelitis biopsies: needle gauge and microbiology results

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Abstract

Purpose

To compare the microbiology results and needle gauge for CT-guided biopsies of suspected discitis-osteomyelitis.

Methods

All CT-guided biopsies performed for suspected discitis-osteomyelitis at our institution between 2002 and 2019 were reviewed. Biopsy location, needle type and gauge, microbiology, pathology, and clinical and imaging follow-up were obtained through chart review. Yield, sensitivity, specificity, and accuracy were calculated. A pairwise analysis of different needle gauges was also performed with calculations of odds ratios. Naïve Bayes predictive modeling was performed.

Results

241 (age: 59 ± 18 years; 88 [35%] F, 162 [65%] M) biopsies were performed. There were 3 (1%) 11 gauge (G), and 13 (5%) 12-G biopsies; 23 (10%) 13-G biopsies; 75 (31%) 14-G biopsies; and 90 (37%) 16-G, 33 (14%) 18-G, and 4 (2%) 20 G biopsies. True disease status (presence of infection) was determined via either pathology findings (205, 86%) or clinical and imaging follow-up (36, 14%). The most common true positive pathogen was Staphylococcus aureus (31, 33%). Overall biopsy yield, sensitivity, specificity, and accuracy were 39%, 56%, 89%, and 66%, respectively. Pooled biopsy yield, sensitivity, specificity, and accuracy was 56%, 69%, 71%, and 69% for 11–13-G needles and 36%, 53%, 91%, and 65% for 14–20-G needles, respectively, with an odds ratio between the two groups of 2.29 (P = 0.021). Pooled biopsy yield, sensitivity, specificity, and accuracy was 48%, 63%, 85%, and 68% for 11–14-G needles and 32%, 49%, 91%, and 64% for 16–20-G needles, respectively, with an odds ratio between the two groups of 2.02 (P = 0.0086).

Conclusion

The use of a larger inner bore diameter/lower gauge biopsy needle may increase the likelihood of culturing the causative microorganism for CT-guided biopsies of discitis-osteomyelitis.

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Authors and Affiliations

  1. Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA

    Jad S. Husseini, F. Joseph Simeone & Connie Y. Chang

  2. Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 20114, USA

    Sandra B. Nelson

Authors
  1. Jad S. Husseini
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  2. F. Joseph Simeone
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Correspondence to Jad S. Husseini.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was waived for individual participants included in the study. The study was approved by the local Institutional Review Board (IRB) and HIPAA compliant.

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Husseini, J.S., Simeone, F.J., Nelson, S.B. et al. CT-guided discitis-osteomyelitis biopsies: needle gauge and microbiology results. Skeletal Radiol 49, 1431–1439 (2020). https://doi.org/10.1007/s00256-020-03439-3

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  • DOI: https://doi.org/10.1007/s00256-020-03439-3

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