Predictors of positive bone cultures from CT‐guided bone biopsies performed for suspected osteomyelitis

Abstract Purpose Apart from the commonly applied manual needle biopsy, CT-guided percutaneous biopsies of bone lesions can be performed with battery-powered drill biopsy systems. Due to assumably different radiation doses and procedural durations, the aim of this study is to examine radiation exposure and establish local diagnostic reference levels (DRLs) of CT-guided bone biopsies of different anatomical regions. Methods In this retrospective study, dose data of 187 patients who underwent CT-guided bone biopsy with a manual or powered drill biopsy system performed at one of three different multi-slice CT were analyzed. Between January 2012 and November 2019, a total of 27 femur (A), 74 ilium (B), 27 sacrum (C), 28 thoracic vertebrae (D) and 31 lumbar vertebrae (E) biopsies were included. Radiation exposure was reported for volume-weighted CT dose index (CTDIvol) and dose–length product (DLP). Results CTDIvol and DLP of manual versus powered drill biopsy were (median, IQR): A: 56.9(41.4–128.5)/66.7(37.6–76.2)mGy, 410(203–683)/303(128–403)mGy·cm, B: 83.5(62.1–128.5)/59.4(46.2–79.8)mGy, 489(322–472)/400(329–695)mGy·cm, C: 97.5(71.6–149.2)/63.1(49.1–83.7)mGy, 627(496–740)/404(316–515)mGy·cm, D: 67.0(40.3–86.6)/39.7(29.9–89.0)mGy, 392(267–596)/207(166–402)mGy·cm and E: 100.1(66.5–162.6)/62.5(48.0–90.0)mGy, 521(385–619)/315(240–452)mGy·cm. Radiation exposure with powered drill was significantly lower for ilium and sacrum, while procedural duration was not increased for any anatomical location. Local DRLs could be depicted as follows (CTDIvol/DLP): A: 91 mGy/522 mGy·cm, B: 90 mGy/530 mGy·cm, C: 116 mGy/740 mGy·cm, D: 87 mGy/578 mGy·cm and E: 115 mGy/546 mGy·cm. The diagnostic yield was 82.4% for manual and 89.4% for powered drill biopsies. Conclusion Use of powered drill bone biopsy systems for CT-guided percutaneous bone biopsies can significantly reduce the radiation burden compared to manual biopsy for specific anatomical locations such as ilium and sacrum and does not increase radiation dose or procedural duration for any of the investigated locations. Level of Evidence Level 3.

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Diagnostic Performance of CT-Guided Bone Biopsies in Patients with Suspected Osteomyelitis of the Appendicular and Axial Skeleton with a Focus on Clinical and Technical Factors Associated with Positive Microbiology Culture Results

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2019.08.013 ◽

2020 ◽

Vol 31 (3) ◽

pp. 464-472 ◽

Cited By ~ 1

Author(s):

Silvia Schirò ◽

Sarah C. Foreman ◽

Matthew Bucknor ◽

Cynthia T. Chin ◽

Gabby B. Joseph ◽

...

Keyword(s):

Diagnostic Performance ◽

Axial Skeleton ◽

Ct Guided ◽

Factors Associated ◽

Bone Biopsies ◽

Technical Factors

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.056 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S91-S91

Author(s):

Cole Hirschfeld ◽

Shashi Kapadia ◽

Joanna Bryan ◽

Deanna Jannat-Khah ◽

Benjamin May ◽

...

Keyword(s):

Antimicrobial Therapy ◽

Gold Standard ◽

Bone Biopsy ◽

Antibiotic Use ◽

Empiric Therapy ◽

Bone Culture ◽

Needle Size ◽

Empiric Antibiotics ◽

Bone Biopsies ◽

Bone Cultures

Abstract 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. Results We 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.

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Detection of PIK3CA Mutations in Breast Cancer Bone Metastases

ISRN Oncology ◽

10.5402/2012/492578 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8

Author(s):

Manijeh Daneshmand ◽

Jennifer E. L. Hanson ◽

Mitra Nabavi ◽

John F. Hilton ◽

Lisa Vandermeer ◽

...

Keyword(s):

Breast Cancer ◽

Bone Marrow ◽

Bone Metastases ◽

Cancer Cells ◽

Primary Tumour ◽

Breast Cancer Patients ◽

Ct Guided ◽

Mutation Status ◽

Bone Biopsies ◽

Metastatic Sites

Background. An important goal of personalized cancer therapy is to tailor specific therapies to the mutational profile of individual patients. However, whole genome sequencing studies have shown that the mutational profiles of cancers evolve over time and often differ between primary and metastatic sites. Activating point mutations in the PIK3CA gene are common in primary breast cancer tumors, but their presence in breast cancer bone metastases has not been assessed previously. Results. Fourteen patients with breast cancer bone metastases were biopsied by three methods: CT-guided bone biopsies; bone marrow trephine biopsies; and bone marrow aspiration. Samples that were positive for cancer cells were obtained from six patients. Three of these patients had detectable PIK3CA mutations in bone marrow cancer cells. Primary tumor samples were available for four of the six patients assessed for PIK3CA status in their bone metastases. For each of these, the PIK3CA mutation status was the same in the primary and metastatic sites. Conclusions. PIK3CA mutations occur frequently in breast cancer bone metastases. The PIK3CA mutation status in bone metastases samples appears to reflect the PIK3CA mutation status in the primary tumour. Breast cancer patients with bone metastases may be candidates for treatment with selective PIK3CA inhibitors.

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CT–Guided Bone Biopsies in Metastatic Castration-Resistant Prostate Cancer: Factors Predictive of Maximum Tumor Yield

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2017.04.019 ◽

2017 ◽

Vol 28 (8) ◽

pp. 1073-1081.e1 ◽

Cited By ~ 18

Author(s):

Michael G. Holmes ◽

Erik Foss ◽

Gabby Joseph ◽

Adam Foye ◽

Brooke Beckett ◽

...

Keyword(s):

Prostate Cancer ◽

Castration Resistant Prostate Cancer ◽

Ct Guided ◽

Castration Resistant ◽

Bone Biopsies ◽

Tumor Yield

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P044 Tibia honest, it takes a lot of spine to diagnose DISC

Rheumatology ◽

10.1093/rheumatology/keab247.041 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Wan Lin Ng ◽

Aqeel Anjum ◽

Joe Devlin ◽

Alexander Fraser

Keyword(s):

Inflammatory Markers ◽

Plasma Cells ◽

Whole Body ◽

Heroin Addiction ◽

Dramatic Improvement ◽

Diagnostic Dilemma ◽

Male Adult ◽

Ct Guided ◽

Osteolytic Lesions ◽

Bone Biopsies

Abstract Background/Aims CRMO is a rare autoinflammatory condition characterised by sterile bone osteolytic lesions which is described mainly in children with a female preponderance. Methods A 31 year-old male presented with a 4-week history of productive cough, abdominal pain, left sided chest pain and right hip pain. He is a smoker with a background of heroin addiction and alcohol abuse. He was homeless and no family history available as he was fostered. His chest radiography was unremarkable but he had inflammatory markers. He was treated for as chest infection and heroin withdrawal. CT abdomen and pelvis demonstrated multiple osteolytic lesions in the pelvis, sternum, thoracic and lumbar spine. His HIV, Quantiferon and blood cultures were negative. His immunoglobulins, urine Bence Jones protein and echocardiogram were normal. In-depth assessment by the Infectious Disease team failed to isolate an infective pathogen. Bone marrow aspirate and trephine were unremarkable. Two CT-guided bone biopsies done twice showed plasma cells and macrophages. His condition deteriorated rapidly over 2 months. He mobility was reduced to wheelchair-bound and had dramatic 10kg weight loss. Results In the absence of an infective or malignant cause, the Rheumatology service was consulted. Having reviewed the extensive data available, he was diagnosed with a likely but unusually aggressive form of adult-onset chronic recurrent multifocal osteomyelitis (CRMO). He was commenced initially on IV methylprednisolone, zoledronic acid, methotrexate and, etoricoxib. Subsequently he was treated with, tocilizumab and teriparatide. Whole body MRI revealed numerous other lesions not evident on previous imaging including lesions of the distal right humerus, proximal right femur and both tibias. His symptoms and inflammatory markers improved substantially over several days following treatment. A repeat full body MRI demonstrated dramatic improvement in the bony lesions. Soon he was able to walk again and gained some weight before he absconded from the hospital. His treatment was changed to tocilizumab infusion and denosumab injection to facilitate compliance. Conclusion This is an unusual fascinating case which posed a significant diagnostic dilemma. Ruling out infection particularly in great challenge in diagnosing CRMO in a male adult who is homeless and a heroin abuser presenting with multifocal osteolytic lesions was challenging. The severity of his condition necessitated using novel treatments such as tocilizumab. Disclosure W. Ng: None. A. Anjum: None. J. Devlin: None. A. Fraser: None.

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68Ga-PSMA-PET/CT and Diffusion MRI Targeting for Cone-Beam CT-Guided Bone Biopsies of Castration-Resistant Prostate Cancer Patients

CardioVascular and Interventional Radiology ◽

10.1007/s00270-019-02312-8 ◽

2019 ◽

Vol 43 (1) ◽

pp. 147-154 ◽

Cited By ~ 1

Author(s):

T. R. F. van Steenbergen ◽

M. Smits ◽

T. W. J. Scheenen ◽

I. M. van Oort ◽

J. Nagarajah ◽

...

Keyword(s):

Diffusion Mri ◽

Cone Beam Ct ◽

Cone Beam ◽

Castration Resistant Prostate Cancer ◽

Ct Guided ◽

Castration Resistant ◽

Psma Pet ◽

Pet Ct ◽

Bone Biopsies ◽

And Diffusion

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Atypical presentation of colorectal carcinoma with sole multiple osteolytic bone metastases: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02795-5 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Ren Kawamura ◽

Yudai Suzuki ◽

Yukinori Harada ◽

Taro Shimizu

Keyword(s):

Colorectal Cancer ◽

Bone Metastases ◽

Diagnostic Delay ◽

Vertebral Osteomyelitis ◽

Gastrointestinal Symptoms ◽

Sudden Onset ◽

Bone Lesions ◽

Ct Guided ◽

Osteolytic Lesions ◽

Bone Biopsies

Abstract Background The incidence of colorectal cancer in persons aged < 50 years has been increasing. The diagnosis of colorectal cancer is not difficult if the patient has typical symptoms; however, diagnosis may be difficult in cases with atypical symptoms and signs. We present here an atypical case of metastatic colorectal cancer with fever and sudden onset paraplegia as the sole manifestations. The patient had multiple osteolytic lesions without gastrointestinal symptoms or signs, which resulted in a diagnostic delay of colorectal cancer. Case presentation A 46-year-old Japanese man was transferred to our hospital for evaluation of fever. He had developed fever 8 weeks previously and had been first admitted to another hospital 5 weeks ago. The patient was initially placed on antibiotics based on the suspicion of a bacterial infection. During the hospital stay, the patient experienced a sudden onset of paralysis and numbness in his both legs. Magnetic resonance imaging showed an epidural mass at the level of Th11, and the patient underwent a laminectomy. Epidural abscess and vertebral osteomyelitis were suspected, and antimicrobial treatment was continued. However, his fever persisted, and he was transferred to our hospital. Chest, abdominal, and pelvic computed tomography (CT) with contrast showed diffusely distributed osteolytic lesions. Fluorodeoxyglucose-positron-emission tomography showed high fluorodeoxyglucose accumulation in multiple discrete bone structures; however, no significant accumulation was observed in the solid organs or lymph nodes. A CT-guided bone biopsy obtained from the left iliac bone confirmed the evidence of metastatic adenocarcinoma based on immunohistochemistry. A subsequent colonoscopy showed a Borrmann type II tumor in the sigmoid colon, which was confirmed to be a poorly differentiated adenocarcinoma. As a result of shared decision-making, the patient chose palliative care. Conclusions Although rare, osteolytic bone metastases as the sole manifestation can occur in patients with colorectal cancer. In patients with conditions difficult to diagnose, physicians should prioritize the necessary tests based on differential diagnoses by analytical clinical reasoning, taking into consideration the patient’s clinical manifestation and the disease epidemiology. Bone biopsies are usually needed in patients only with sole osteolytic bone lesions; however, other rapid and useful non-invasive diagnostic tests can be also useful for narrowing the differential diagnosis.

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Assessment of suspected bone metastases

Acta Radiologica ◽

10.1080/02841859709172431 ◽

1997 ◽

Vol 38 (5) ◽

pp. 890-895 ◽

Cited By ~ 3

Author(s):

I. Çiray ◽

G. Åström ◽

C. Sundström ◽

H. Hagberg ◽

H. Ahlström

Keyword(s):

Bone Metastases ◽

Bone Biopsy ◽

Clinical Information ◽

Benign Lesions ◽

True Negative ◽

Ct Guided ◽

Negative Results ◽

Skeletal Lesion ◽

Bone Biopsies ◽

Malignant Lesions

Purpose: To evaluate the role of CT with and without clinical information as compared to CT-guided bone biopsy in the assessment of suspected bone metastases. Material and Methods: The study comprised 51 consecutive patients with suspected bone metastases who had undergone CT-guided bone biopsies with an eccentric drill system. CT of the targets, clinical information, and histopathology were scored separately as malignant, uncertain or benign. The results of CT alone and CT in combination with clinical information were compared to the results of histopathology. Results: Histopathology diagnosed 45/51 lesions (88%), 23 as malignant and 22 as benign. CT correctly depicted 17 of these 23 malignant lesions. The remaining 6 malignant lesions were CT-scored as uncertain (n=5) or benign (n=l). CT correctly depicted only 3 of the 22 benign lesions. The remaining 19 benign lesions were CT-scored as malignant (n=2) or uncertain (n=17). When uncertain CT scores were combined with clinical scores, the true-positive and true-negative results for malignancy increased from 44% to 82%. Conclusion: In most cases, CT in combination with clinical information gives enough information about the nature — malignant or benign — of a skeletal lesion. In uncertain cases, diagnostic accuracy can be improved by means of CT-guided bone biopsy.

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