Culture yield of repeat percutaneous image-guided biopsy after a negative initial biopsy in suspected spondylodiscitis: a systematic review

Abstract

ObjectiveTo systematically review the published data on the culture yield of a repeat (second) percutaneous image-guided biopsy after negative initial biopsy in suspected spondylodiscitis.Materials and methodsA systematic search was performed of the PubMed/Medline and Embase databases. The methodological quality of the studies included was assessed. The proportions of positive cultures among all initial biopsies and second biopsies (after a negative initial biopsy) were calculated for each study and assessed for heterogeneity (defined as I2 > 50%).ResultsEight studies, comprising a total of 107 patients who underwent a second percutaneous image-guided biopsy after a culture-negative initial biopsy in suspected spondylodiscitis, were included. All eight studies were at risk of bias and were concerning with regard to applicability, particularly patient selection, flow of patients through the study, and timing of the biopsy. The proportions of positive cultures among all initial biopsies ranged from 10.3 to 52.5%, and were subject to heterogeneity (I2 = 73.7%). The proportions of positive cultures among all second biopsies after negative initial biopsy ranged from 0 to 60.0%, and were not subject to heterogeneity (I2 = 38.7%).ConclusionAlthough a second percutaneous image-guided biopsy may have some value in patients with suspected spondylodiscitis, its exact value remains unclear, given the available poor-quality evidence. Future well-designed studies are needed to determine the role of a second percutaneous image-guided biopsy in this setting. Such studies should clearly describe the spectrum of patients that was selected for a second percutaneous image-guided biopsy, the method of biopsy, and differences compared with the first biopsy, if any.

Time to Reconsider Routine Percutaneous Biopsy in Spondylodiscitis?

“…9 The latter percentage of 33% corroborates both the results of some more recent original studies investigating the microbiological yield of the first biopsy in suspected spondylodiscitis 10,11 and a meta-analysis that included 8 studies on the culture yield of repeat biopsy after an initial biopsy with negative findings. 12 This percentage is also considerably lower than the 30%-74% range that was described in the Infectious Diseases Society of America guidelines. 2,3 Furthermore, cultures may be positive for possible skin contaminants such as coagulase-negative Staphylococcus species (except Staphylococcus lugdunensis) and Cutibacterium species; thus, the spinal or paraspinal biopsy culture may be inconclusive.…”

“…The practical disadvantages of percutaneous image-guided biopsy [5][6][7][8] and the relatively low positive culture yield of 33% [9][10][11][12] raise the question of whether this procedure should be routinely performed in all patients with suspected spondylodiscitis. Some recent evidence can also be considered supportive of this potential paradigm shift.…”

Optimal microbiological sampling for the diagnosis of osteoarticular infection

“…When the initial biopsy is negative, a second attempt may be performed although its real worth is unclear with results in the literature ranging from 0–60%. 51 , 55 , 56 It is still unclear why the diagnostic yield is so low in comparison to other specimen acquisition methods. Unlike other contexts in orthopaedics, it is not clear that bone tissue samples are advantageous over soft tissue sampling with conflicting results in the literature.…”

Infektionen der Wirbelsäule – Spondylodiszitis

“…2 b). Diese Methode ist sicher, minimalinvasiv und gut etabliert, erzielt aber in den neuesten Studien nur in 10-53 % der Fälle einen Erregernachweis im Vergleich zu 91 % in älteren Studien [14,15].…”