Image-guided Bone Biopsy Research Articles

Yield and clinical impact of image-guided bone biopsy in osteomyelitis of the appendicular skeleton: a systematic review and meta-analysis.

To assess the yield and clinical impact of image-guided bone biopsy for osteomyelitis of the appendicular skeleton. A literature search of several databases was conducted from inception to August 2023. Eligible studies reported patients who underwent image-guided bone biopsy for investigation of osteomyelitis of the appendicular skeleton. The pooled proportions were analyzed using a random-effects model. This review was registered in PROSPERO (CRD42023466419). From 370 initial studies screened, eight met the eligibility criteria, with a total of 700 patients. The pooled technical success rate was 99.6% (95% CI: 0.992, 1.001; I2 = 0%). Positive bone cultures were pooled at 31.9% (95% CI: 0.222, 0.416; I2 = 87.83%) and negative cultures at 68.1% (95% CI: 0.584, 0.778; I2 = 87.83%). Methicillin-Sensitive Staphylococcus Aureus and Methicillin-Resistant Staphylococcus Aureus yield was 24.5% (95% CI: 0.096, 0.394; I2 = 90.98%) and 7.6% (95% CI: 0.031, 0.121; I2 = 34.42%) respectively. Group A Streptococcus yield was 7.0% (95% CI: 0.014, 0.127; I2 = 70.94%). Polymicrobial culture yield was 15.7% (95% CI: 0.018, 0.297; I2 = 88.90%). Post-procedural management change rate was 36.5% (95% CI: 0.225, 0.504; I2 = 92.39%). No complications were reported across studies. For patients under investigation of osteomyelitis of the appendicular skeleton, image-guided bone biopsy demonstrates a good rate of technical success. Additional studies may provide further support for the use of image-guided bone biopsy in this population. Image-guided bone biopsy results lead to change in antibiotics therapy in a portion of patients with suspected osteomyelitis suggesting its potential utility in select patients.

Is fluoroscopy-guided percutaneous bone biopsy of diabetic foot with suspected osteomyelitis worthwhile? A retrospective study.

Diabetic foot infection, particularly osteomyelitis, is a major risk factor of amputation in persons with diabetes. Bone biopsy with microbial examination is considered the gold standard of diagnosis of osteomyelitis, providing information about the offending pathogens as well as their antibiotics susceptibility. This allows targeting of these pathogens with narrow spectrum antibiotics, potentially reducing emergence of antimicrobial resistance. Percutaneous fluoroscopy guided bone biopsy allows accurate and safe targeting of the affected bone. In a single tertiary medical institution and over 9 year period, we performed 170 percutaneous bone biopsies. We retrosepctively reviewed the medical record of these patients including patients' demographics, imaging and biopsy microbiology and pathollogic results. Microbiological cultures of 80 samples (47.1%) were positive with 53.8% of the positive culture showed monomicrobial growth and the remaining were polymicrobial. Of the positive bone samples 71.3% grew Gram-positive bacteria. Staphylococcus aureus was the most frequently isolated pathogen from positive bone cultures with almost one third showing methicillin resistence. Enterococcus species were the most frequently isolated pathogens from polymicrobial samples. Enterobacteriaceae species were the most common Gram-negative pathogens and were more common in polymicrobial samples. Percutaneous image-guided bone biopsy is a low-risk, minimally invasive procedure that can provide valuable information about microbial pathogens and therefore enable targeting these pathogens with narrow spectrum antibiotics.

Abstract No. 312 Image-guided bone biopsy does not significantly impact short-term clinical outcomes for osteomyelitis of the appendicular skeleton: a single-center experience

To determine the microbiologic yield for patients undergoing image-guided bone biopsy (IGBB) for patients with radiologically suspected osteomyelitis. Additionally, to determine if IGBB for suspected osteomyelitis impacts antibiotic management.

Impact of diagnostic bone biopsies on the management of non-vertebral osteomyelitis: A retrospective cohort study.

Optimal antibiotic management of patients with osteomyelitis remains a challenge for many clinicians. Although image-guided bone biopsy (IGB) remains the gold standard, its role in confirming diagnosis and guiding antibiotic management is not clear in patients with non-vertebral osteomyelitis.To determine the diagnostic yield of IGB and its impact on antibiotic management in non-vertebral osteomyelitis.Retrospective cohort study.Urban academic medical center.Patients admitted for non-vertebral osteomyelitis who underwent image-guided bone biopsy.Primary outcomes were microbiologic and histopathological results. We evaluated the impact of IGB on clinician-initiated changes in antibiotic regimen before and after biopsy.We evaluated 203 bone biopsies in 185 patients with clinical suspicion of osteomyelitis. 79% of patient received antibiotics prior to biopsy. Bone cultures were positive in 28% and histopathology confirmed osteomyelitis in 29%, but concordance was poor. Furthermore, clinical suspicion of infection was much higher, given that 68% received empiric antibiotics. Leukocytosis was significantly associated with positive cultures in multivariate analysis. There was no statistically significant correlation between antibiotic management and bone culture results. When culture yielded an organism, empiric regimens were kept the same, broadened or narrowed with equal frequency; targeted regimens were chosen only in 4 cases. Despite negative cultures in 98/138 cases having received empiric treatment, antibiotics were discontinued in only 8 cases. Even when empiric treatment was not given, negative cultures did not dissuade clinicians from eventual antibiotic use in a significant number of cases (17/48). In 46/71 patients whose final regimen included vancomycin, there was no evidence of current or past infection with MRSA.In patients with non-vertebral osteomyelitis, the diagnostic yield of image-guided bone biopsy is low, and clinicians frequently make decisions regarding antibiotic management that are not aligned with culture results.

04:03 PM Abstract No. 303 Percutaneous image-guided bone biopsy for suspected pediatric osteomyelitis

Osteomyelitis in children can produce significant debilitation and broadly includes infectious (acute and chronic) and non-infectious osteomyelitis, including chronic recurrent multifocal osteomyelitis (CRMO). Biopsy is often performed to aid in diagnosis and to identify the pathogen, frequently in cases wherein best management, based on clinical presentation, is ambiguous. The aim of our study was to characterize the yield and assess efficacy of image-guided bone biopsy for pediatric osteomyelitis. This was a retrospective review of patients with suspected osteomyelitis based on clinical data and imaging who underwent percutaneous bone biopsy in interventional radiology over a 10-year period at a tertiary pediatric hospital. Review parameters included procedural technical data and clinical data, including details of clinical presentation and microbiology and pathology results. 40 patients (mean age 9.5y, range 0.4-25.8y) underwent biopsy. Fluoroscopy was used in 29 cases, with rotational CT in 16 cases. Of these 16, Syngo iGuide guidance software was used in 9 cases, and MRI overlay was used in 4. CT guidance was used in 9. Additional US guidance for adjacent soft tissue component was used in 17 cases. Mean procedure time was 85 minutes, and mean fluoroscopy time was 3.6 min. A 16G bone biopsy cannula was utilized in 34 cases; a 13G cannula in 5; and an 11G in 1 case. The mean number of bone cores obtained was 3.6. Biopsy culture yielded a pathogen in 4 of 40 cases, and culture results did not show significant correlation with lesion location, fever, leukocytosis/blood culture, ESR/CRP, number of cores, instrument gauge, or aspiration of marrow. There was pathology adequacy in 100%. Based on culture and pathology results, 22 patients were diagnosed with infectious osteomyelitis (13 chronic and 9 acute) and were placed on antibiotic therapy. Fifteen patients were diagnosed with CRMO, based on pathology result. Although culture yield of bone biopsy was low, pathology results showed adequacy and aided in management of patients with suspected osteomyelitis. Results support bone biopsy as a safe and effective means to aid in management of pediatric osteomyelitis.

Percutaneous image-guided bone biopsy of osteomyelitis in the foot and pelvis has a low impact on guiding antibiotics management: a retrospective analysis of 60 bone biopsies.

Image-guided percutaneous bone biopsy may be requested by clinicians to guide antibiotics management decisions in patients with extremity osteomyelitis. Much of the clinical literature describes a high rate of bone biopsy culture positivity in patients with osteomyelitis, but anecdotally biopsy is felt to be fairly low yield in many musculoskeletal radiology practices. The objective of the study is to determine the culture positivity rate and clinical utility of bone biopsy in guiding the management of patients with osteomyelitis. All image-guided bone biopsy procedures of the pelvis or foot performed at a single institution were identified by a retrospective report search, and only those with a clinical suspicion for infection were included. Cases were included based on convincing imaging findings of osteomyelitis on retrospective review. Microbiology results were reviewed in the clinical chart, as were antibiotics management decisions and response to antibiotics therapy. A total of 60 bone biopsies met the inclusion criteria, 25 within the foot and 35 biopsies of the pelvis. Overall, 11 out of 60 core biopsies (18%) yielded positive cultures. Antibiotics management was altered in only 27% patients with a positive culture; thus, only 5% of patients with MRI findings of osteomyelitis undergoing biopsy had an impact on management. Percutaneous bone biopsies may have a low rate of culture positivity, and even when positive, frequently do not have an impact on antibiotics choice. These data differ from much of the clinical literature, which describes a very high rate of culture positivity.

Bone and Soft-Tissue Biopsies: What You Need to Know.

Percutaneous, image-guided musculoskeletal biopsy, due to its minimal invasive nature, when compared with open surgical biopsy, is a safe and effective technique which is widely used in many institutions as the primary method to acquire tissue and bone samples. Indications include histopathologic and molecular assessment of a musculoskeletal lesion, exclusion of malignancy in a bone/vertebral fracture, examination of bone marrow, and infection investigation. Preprocedural workup should include both imaging (for lesion assessment and staging) and laboratory (including coagulation tests and platelet count) studies. In selected cases, antibiotic prophylaxis should be administered before the biopsy. Core needle biopsy of musculoskeletal lesions has a diagnostic accuracy that ranges from 66 to 98% with higher diagnostic yield for lytic, large-size, malignant lesions and when multiple and long specimens are obtained. Reported complication rates range between 0 and 10% and usually do not exceed 5%, with a suggested threshold of 2%. The purpose of this review article is to illustrate the technical aspects, the indications, and the methodology of percutaneous image-guided bone biopsy that will assist the interventional radiologist to perform these minimal invasive techniques.

Bone biopsy protocol for advanced prostate cancer in the era of precision medicine.

Metastatic biopsies are increasingly being performed in patients with advanced prostate cancer to search for actionable targets and/or to identify emerging resistance mechanisms. Due to a predominance of bone metastases and their sclerotic nature, obtaining sufficient tissue for clinical and genomic studies is challenging. Patients with prostate cancer bone metastases were enrolled between February 2013 and March 2017 on an institutional review board-approved protocol for prospective image-guided bone biopsy. Bone biopsies and blood clots were collected fresh. Compact bone was subjected to formalin with a decalcifying agent for diagnosis; bone marrow and blood clots were frozen in optimum cutting temperature formulation for next-generation sequencing. Frozen slides were cut from optimum cutting temperature cryomolds and evaluated for tumor histology and purity. Tissue was macrodissected for DNA and RNA extraction, and whole-exome sequencing and RNA sequencing were performed. Seventy bone biopsies from 64 patients were performed. Diagnostic material confirming prostate cancer was successful in 60 of 70 cases (85.7%). The median DNA/RNA yield was 25.5 ng/μL and 16.2 ng/μL, respectively. Whole-exome sequencing was performed successfully in 49 of 60 cases (81.7%), with additional RNA sequencing performed in 20 of 60 cases (33.3%). Recurrent alterations were as expected, including those involving the AR, PTEN, TP53, BRCA2, and SPOP genes. This prostate cancer bone biopsy protocol ensures a valuable source for high-quality DNA and RNA for tumor sequencing and may be used to detect actionable alterations and resistance mechanisms in patients with bone metastases. Cancer 2018;124:1008-15. © 2017 American Cancer Society.

Utility of Diagnostic Bone Biopsies in the Management of Osteomyelitis Through Retrospective Analysis: How Golden Is This Gold Standard?

Background Bone biopsy is considered the gold standard for diagnosis and treatment of osteomyelitis (OM), but few studies have investigated the extent to which it influences antimicrobial therapy in non-vertebral bones. The purpose of this study was to evaluate clinician-initiated changes to empiric antimicrobial therapy after obtaining bone biopsy results. A secondary aim was to identify predictors of a positive bone culture.Methods We retrospectively reviewed all cases of non-vertebral OM in patients who underwent image-guided bone biopsies between 2009 and 2016. Data on pathologic and microbiologic yield were collected and logistic regression was used to determine potential factors affecting the microbiologic yield. Post-biopsy empiric antibiotics and final antibiotics were compared with determine if there was a change in antibiotic treatment after biopsy results were reported.ResultsWe evaluated 203 bone biopsies in 185 patients. Samples from 115 (57%) cases were sent to pathology, of which 33 (29%) confirmed OM. All samples were sent to microbiology and 57 (28%) yielded a positive result. Diabetes (OR=2.39, P = 0.021) and white blood cell count (OR=1.13, P = 0.006) were significantly associated with positive bone cultures in multivariate analyses. There was no association between positive cultures and number of samples cultured, needle size, prior antibiotic use, or antibiotic-free days. Post-biopsy empiric antibiotics were given in 138 (68%) cases. Therapy was narrowed to target specific organisms in seven cases and changed due to inadequate empiric treatment in three cases. Targeted therapy was initiated in 4/65 cases, in which empiric antibiotics had been initially withheld. While final antibiotics were withheld in 38/146 with negative bone cultures, empiric antibiotics were discontinued in only eight cases.Conclusion In patients with non-vertebral OM, bone biopsy cultures rarely yielded results that necessitated changes in antibiotic management. Identified bone organisms were treated by empiric therapy in most patients. While bone biopsy remains the gold standard diagnostic test for OM, further work is needed to identify patients whose management may be impacted by this procedure.Disclosures All authors: No reported disclosures.

Technique, Safety, and Yield of Bone Biopsies for Histomorphometry in Children

PurposeTo evaluate image-guided bone biopsy for bone histomorphometry to assess osteoporosis in children with respect to safety and yield. Materials and MethodsA single-center retrospective review was performed of 79 bone biopsies in 73 patients performed between 2007 and 2015. Biopsies of the iliac bone were performed under general anesthesia, after tetracycline labeling, using a Rochester needle (Medical Innovations International, Inc, Rochester, Minnesota). Ultrasound and fluoroscopic guidance were used in all procedures. Biopsy technique, technical success, safety, and histomorphometry results (complete, incomplete, none) were analyzed. ResultsThere were 41 male patients (51.8%). Technical success was achieved in 76/79 (96%) procedures. Of 79 biopsies, 75 (95%) were uneventful. Unplanned overnight observation was required in 3 (minor SIR grade B), and prolonged hospital stay owing to hematoma causing nerve compression pain was required in 1 (major SIR grade D). Complete histomorphometric reports were obtained in 69 (87%) procedures, incomplete reports were obtained in 7 (9%), and no reports were obtained in 3(4%). Incomplete reports were insufficient to provide a definitive diagnosis or guide treatment. Histomorphometry impacted subsequent therapy in 69 (87%) biopsies. ConclusionsImage-guided bone biopsy for osteoporosis using the Rochester needle is a valuable and safe technique for establishing the diagnosis of osteoporosis and directing treatment based on histomorphometry results.

Desmoplastic fibroma of the distal tibia: A case report of a minimally invasive histological diagnosis.

Desmoplastic fibroma (DF) is a benign, rare fibroblastic intraosseous neoplasm histologically resembling a desmoid soft tissue tumor. Although classified as benign, DF frequently exhibits an aggressive behavior, has a moderate-to-high recurrence rate, and often causes pathological fractures and extensive bone destruction. This case report presents an incidentally detected DF of the tibia, which was diagnosed using a minimally invasive approach. A 36-year-old African female patient was referred to the Department of Diagnostic Imaging of Arcispedale Santa Maria Nuova-IRCCS (Reggio Emilia, Italy), to be examined by a computed tomography scan on an outpatient basis, after an x-ray examination of the tibia, which was performed after an injury to exclude the presence of a fracture, revealed a hyperlucency of unknown origin. The aim of this study was to discuss the clinical, histological, immunohistochemical and radiographic characteristics of this rare neoplasm, with a focus on image-guided bone biopsy.

Correlation of Rapid On-Site Evaluation with Final Diagnosis in Image-Guided Bone Biopsies

Correlation of Rapid On-Site Evaluation with Final Diagnosis in Image-Guided Bone Biopsies

TH-A-WAB-05: Selection of Candidate Lesions for Image-Guided Bone Biopsy Using [F-18]NaF PET/CT Response to Therapy

Purpose: Site selection for image‐guided biopsies in patients with multiple lesions is typically based on physician preference and clinical feasibility. This study aims to develop a method to additionally incorporate quantitative imaging data for automatic selection of candidate lesions for post‐treatment bone biopsy, using [18F]NaF response metrics in combination with physician feasibility. Methods: 12 metastatic prostate cancer patients undergoing conventional treatment received whole‐body [18F]NaF PET/CT scans pre‐and mid‐treatment. We quantitatively optimized biopsy lesion selection by maximizing a lesion‐specific objective function score(OFS). Here, OFS is defined as the weighted global sum of seven criteria separated into two categories: 1)physician‐feasibility category including physician‐preferred lesion location and absolute volume scores, and 2)imaging‐response category including four imaging response metrics (lesion volume, SUVmax, SUVmean, SUVtotal %change from pre‐to mid‐treatment) and an overall response score. Criteria were weighted evenly within each category. Weighting ratios between physician‐feasibility and imaging‐response (PF:IR) were varied from 2:1 to 1:2 to test OFS sensitivity. Results: 102 of 650+ total lesions met minimum criteria to qualify for biopsy. Within patients, maximum OFS ranged from <1%–27% greater than the next highest scoring lesion, indicating some patients have multiple lesions desirable for biopsy. Assessing sensitivity, within‐patient lesion rankings based on OFS values were stable from 1:1‐to‐2:1 (R=0.94), 1:1‐to‐1:2 (R=0.96), and from 1:2‐to‐2:1 (R=0.81) for all lesions. Compared to 1:1, the lesion identified as having the maximum OFS remained top‐seeded in 5 patients and in the top three highest ranking lesions in all patients for both 1:2 and 2:1. After selecting optimal candidates, biopsy feasibility was confirmed by the physician for 32/36 high‐ranking lesions, of which all top choices were confirmed. Conclusion: This newly developed computational optimization method was successfully used to quantitatively identify candidate lesions for bone biopsies. The method was robust to different weighting ratios and candidacy for biopsy was physician confirmed.

Pediatric Image-Guided Nonvascular Musculoskeletal Interventions

Image-guided procedures involving the musculoskeletal (MSK) system of children can be challenging because of the variability posed by the child's age, skeletal maturity, and the stage of development. The imaging findings of the maturing MSK system and the underlying diseases affecting children, particularly those that are skeletally immature, can differ significantly from typical adults. The breadth of possible MSK procedures performed by an interventional radiology service depends on the availability of local expertise/experience as well as the referral patterns. In our practice, the majority of nonvascular MSK procedures involve children with a sequela of pain and in need of a therapeutic intervention. We describe our techniques for our more commonly performed MSK procedures, including corticosteroid injections, treating osteoid osteomas, and performance of image-guided bone biopsies and foreign body removal.

PET/CT-guided biopsies of metabolically active bone lesions: applications and clinical impact

In a minority of cases a definite diagnosis and stage grouping in cancer patients is not possible based on the imaging information of PET/CT. We report our experience with percutaneous PET/CT-guided bone biopsies to histologically verify the aetiology of hypermetabolic bone lesions. We retrospectively reviewed the data of 20 consecutive patients who underwent multimodal image-guided bone biopsies using a dedicated PET/CT system in a step-by-step technique. Technical and clinical success rates of PET/CT-guided biopsies were evaluated. Questionnaires were sent to the referring physicians to assess the impact of biopsies on patient management and to check the clinical need for PET/CT-guided biopsies. Clinical indications for biopsy were to histologically verify the aetiology of metabolically active bone lesions without a morphological correlate confirming the suspicion of metastases in 15 patients, to determine the origin of suspected metastases in 3 patients and to evaluate the appropriateness of targeted therapy options in 2 patients. Biopsies were technically successful in all patients. In 19 of 20 patients a definite histological diagnosis was possible. No complications or adverse effects occurred. The result of PET/CT-guided bone biopsies determined a change of the planned treatment in overall 56% of patients, with intramodality changes, e.g. chemotherapy with palliative instead of curative intent, and intermodality changes, e.g. systemic therapy instead of surgery, in 22 and 50%, respectively. PET/CT-guided bone biopsies are a promising alternative to conventional techniques to make metabolically active bone lesions-especially without a distinctive morphological correlate-accessible for histological verification. PET/CT-guided biopsies had a major clinical impact in patients who otherwise cannot be reliably stage grouped at the time of treatment decisions.