Yield of Image-Guided Needle Biopsy for Infectious Discitis: A Systematic Review and Meta-Analysis

AJNR Am J Neuroradiol. 2017 Oct;38(10):2021-2027. doi: 10.3174/ajnr.A5337. Epub 2017 Sep 7.

Abstract

Background: Image-guided biopsy is routinely conducted in patients with suspected discitis, though the sensitivity reported in the literature ranges widely.

Purpose: We applied a systematic review and meta-analysis to estimate the yield of image-guided biopsy for infectious discitis.

Data sources: We performed a literature search of 4 data bases: PubMed, Cochrane CENTRAL Register of Controlled Trials, Embase.com, and Scopus from data base inception to March 2016.

Study selection: A screen of 1814 articles identified 88 potentially relevant articles. Data were extracted for 33 articles, which were eligible if they were peer-reviewed publications of patients with clinical suspicion of discitis who underwent image-guided biopsy.

Data analysis: Patients with positive cultures out of total image-guided biopsy procedures were pooled to estimate yield with 95% confidence intervals. Hypothesis testing was performed with an inverse variance method after logit transformation.

Data synthesis: Image-guided biopsy has a yield of approximately 48% (793/1763), which is significantly lower than the open surgical biopsy yield of 76% (152/201; P < .01). Biopsy in patients with prior antibiotic exposure had a yield of 32% (106/346), which was not significantly different from the yield of 43% (336/813; P = .08) in patients without prior antibiotic exposure.

Limitations: The conclusions of this meta-analysis are primarily limited by the heterogeneity of the included studies.

Conclusions: Image-guided biopsy has a moderate yield for the diagnosis of infectious discitis, which is significantly lower than the yield of open surgical biopsy. This yield is not significantly affected by prior antibiotic use.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Biopsy, Needle / methods*
  • Discitis / diagnostic imaging*
  • Discitis / pathology*
  • Humans
  • Image-Guided Biopsy / methods*
  • Infections / diagnostic imaging*
  • Infections / pathology*