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

Objectives The diagnostic yield and clinical impact of image-guided core needle biopsy(ICNB) of suspected vertebral osteomyelitis in adults is heterogenous in published studies due to small sample size, indicating the need for large cohort studies. Methods A retrospective analysis of ICNBs was performed from 2010-2021 for patients with imaging findings consistent with vertebral 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. Results A total of 570 biopsies performed on 527 patients were included. A histopathologic diagnosis of osteomyelitis was made in 68.4%(359/525) of biopsies, and microbiological cultures were positive in 29.6%(169/570). Elevated ESR was positively associated with a histopathologic diagnosis of osteomyelitis(OR=1.96, p=0.007), and positive cultures from bone cores(OR=1.02,p=<0.001) and aspirate(OR=1.02,p=<0.001). Increased total core length was positively associated with a histopathologic diagnosis of osteomyelitis(OR=1.81,p=0.013), and positive cultures from bone cores (OR=1.65,p=0.049). Clinical management was affected by ICNB in 37.5%(214/570) of cases. Conclusion In this large cohort, ICNB yielded approximately 30% positive cultures and changed clinical management in over one-third of patients.