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Hassold N, Bihan H, Moumba YP, Poilane I, Méchaï F, Assad N, Labbe-Gentils V, Sal M, Koutcha ON, Martin A, Radu D, Martinod E, Cordel H, Vignier N, Tatulashvili S, Berkane N, Carbonnelle E, Bouchaud O, Cosson E. BedBiopsy: diagnostic performance of bedside ultrasound-guided bone biopsies for the management of diabetic foot infection. Diabetes Metab 2024:101525. [PMID: 38442769 DOI: 10.1016/j.diabet.2024.101525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE - We aimed to assess the feasibility and diagnostic performance of ultrasound-guided bone biopsies at the bedside of diabetic patients admitted for suspected foot osteitis not requiring surgery. RESEARCH DESIGN AND METHODS - In this retrospective monocentric study, we compared the performance of ultrasound-guided (n=29 consecutive patients, Dec.2020-Oct.2022) versus surgical (n=24 consecutive patients, Jan.2018-Nov.2020) bone biopsies at confirming or ruling out diabetic foot osteitis (primary outcome). RESULTS - Patient characteristics were similar in the two intervention groups, including arteritis prevalence (62.3%), SINBAD score, and wound location (phalanges 36%, metatarsus 43%, and calcaneus 21%). However, the ultrasound-guided group was older (67 ± 11 versus 60 ± 13 years respectively, P = 0.047) and had more type 2 diabetes (97% versus 75%, P = 0.038). Diagnostic performance (i.e., capacity to confirm or rule out suspected osteitis) was similar for ultrasound-guided (28/29 cases: 25 confirmations, 3 invalidations) and surgical (24 confirmations/24) biopsies, P = 0.358. No biopsy-related side effect or complication was observed for either intervention, even for patients on antiaggregation and/or anticoagulation therapy. The mean (± standard deviation) time necessary to perform the biopsy was shorter in the ultrasound-guided group (2.6 ± 3.0 versus 7.2 ± 5.8 days, respectively, P < 0.001) and wound evolution at three months was more favorable (83.3 versus 41.2%, P = 0.005) (94.4% versus 66.7%, respectively, patients with new surgical procedure within six months excluded; P = 0.055). Even though not statistically significant, healing rates in terms of wound and osteitis at six months were also better in the ultrasound-guided group (wound: 40.9% versus 36.8%; P = 0.790, and osteitis: 81.8 vs 55.6% P = 0.071). CONCLUSION - In diabetic patients with suspected foot osteitis not requiring surgery, bedside ultrasound-guided bone biopsies may constitute a promising alternative to surgical biopsies. This intervention provided excellent tolerance and microbiological documentation, short lead-times, and more favorable wound prognosis.
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Affiliation(s)
- Nolan Hassold
- Department of infectious diseases, Avicenne Hospital, Hôpitaux universitaires Paris Seine-Saint-Denis, AP-HP, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France.
| | - Hélène Bihan
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France; LEPS (Laboratoire Educations et Promotion de la Santé) EA 3412-Université Paris 13
| | - Yolène Pambo Moumba
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
| | | | - Frédéric Méchaï
- Department of infectious diseases, Avicenne Hospital, Hôpitaux universitaires Paris Seine-Saint-Denis, AP-HP, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France
| | - Nabil Assad
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
| | - Véronique Labbe-Gentils
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
| | - Meriem Sal
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
| | - Omar Nouhou Koutcha
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
| | - Antoine Martin
- Department of anatomopathology, Avicenne Hospital, Bobigny, France
| | - Dana Radu
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny
| | - Emmanuel Martinod
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny
| | - Hugues Cordel
- Department of infectious diseases, Avicenne Hospital, Hôpitaux universitaires Paris Seine-Saint-Denis, AP-HP, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France
| | - Nicolas Vignier
- Department of infectious diseases, Avicenne Hospital, Hôpitaux universitaires Paris Seine-Saint-Denis, AP-HP, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France; IAME, INSERM UMR 1137, Université Sorbonne Paris Nord, Bobigny, France
| | - Sopio Tatulashvili
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
| | - Narimane Berkane
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
| | | | - Olivier Bouchaud
- Department of infectious diseases, Avicenne Hospital, Hôpitaux universitaires Paris Seine-Saint-Denis, AP-HP, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France
| | - Emmanuel Cosson
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France; Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Bobigny, France
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Fischer E, Gebremeskel M, Stoianovici D, Sharma K, Cleary K. A novel pneumatic drill for bone biopsy under MRI imaging. Int J Comput Assist Radiol Surg 2024; 19:405-409. [PMID: 38148438 DOI: 10.1007/s11548-023-03042-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/22/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Bone biopsies are currently conducted under computed tomography (CT) guidance using a battery-powered drill to obtain tissue samples for diagnosis of suspicious bone lesions. However, this procedure is suboptimal as images produced under CT lack soft tissue discrimination and involve ionizing radiation. Therefore, our team developed an MRI-safe pneumatic drill to translate this clinical workflow into the MR environment, which can improve target visualization and eliminate radiation exposure. We compare drill times and quality of samples between the 2 drills using animal bones. METHODS Five porcine spare rib bones were obtained from a butcher shop. Each bone was drilled twice using the Arrow OnControl battery-powered drill and twice using our pneumatically actuated drill. For this study, we used an 11-gauge bone biopsy needle set with an internal core capturing thread. A stopwatch recorded the overall time of drilling for each specimen obtained. RESULTS All 20 samples collected contained a high-quality inner core and cortex. The total average time for drilling with the pneumatic drill was 8.5 s (+ / - 2.5 s) and 7.1 s (+ / - 1.4 s) with the standard battery-powered drill. CONCLUSION Both drills worked well and were able to obtain comparable specimens. The pneumatic drill took slightly longer, 1.39 s on average, but this extra time would not be significant in clinical practice. We plan to use the pneumatic drill to enable MRI-safe bone biopsy for musculoskeletal lesions. Biopsy under MRI would provide excellent lesion visualization with no ionizing radiation.
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Affiliation(s)
- Elizabeth Fischer
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA.
| | - Mikias Gebremeskel
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
| | - Dan Stoianovici
- Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Karun Sharma
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
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Pereira L, Mendonça L, Magalhães J, Neto R, Quelhas-Santos J, Oliveira A, Beco A, Frazão J. Vascular calcification in peritoneal dialysis patients and its association with bone-derived molecules and bone histomorphometry. Nefrologia 2024; 44:224-232. [PMID: 37179214 DOI: 10.1016/j.nefroe.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/10/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Data regarding vascular calcification (VC) in contemporary peritoneal dialysis (PD) patients is scarce. Bone-vascular axis has been demonstrated in hemodialysis (HD). However, studies showing the link between bone disease and VC in PD patients are lacking. The role of sclerostin, dickkopf-related protein 1 (DKK-1), receptor activator for nuclear factor kB ligand and osteoprotegerin (OPG) in VC in PD remains to clarify. MATERIALS AND METHODS Bone biopsy was performed in 47 prevalent PD patients with histomorphometric analysis. Patients were submitted to pelvis and hands X-ray to evaluate VC using the Adragão score (AS). Relevant clinical and biochemical data was collected. RESULTS Thirteen patients (27.7%) had positive AS (AS≥1). Patients with VC were significantly older (58.9 vs. 50.4 years, p=0.011), had a lower dialysis dose (KT/V 2.0 vs. 2.4, p=0.025) and a higher glycosylated hemoglobin (7.2 vs. 5.4%, p=0.001). There was not any laboratorial parameter of mineral and bone disease used in clinical practice different between patients with or without VC. All diabetic patients had VC but only 8.1% of non-diabetic had VC (p<0.001). Patients with VC showed significantly higher erythrocyte sedimentation rate (ESR) (91.1 vs. 60.0mm/h, p=0.001), sclerostin (2250.0 vs. 1745.8pg/mL, p=0.035), DKK-1 (1451.6 vs. 1042.9pg/mL, p=0.041) and OPG levels (2904.9 vs. 1518.2pg/mL, p=0.002). On multivariate analysis, only ESR remained statistically significant (OR 1.07; 95% CI 1.01-1.14; p=0.022). Bone histomorphometric findings were not different in patients with VC. There was no correlation between bone formation rate and AS (r=-0.039; p=0.796). CONCLUSION The presence of VC was not associated with bone turnover and volume evaluated by bone histomorphometry. Inflammation and diabetes seem to play a more relevant role in VC in PD.
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Affiliation(s)
- Luciano Pereira
- Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal; INEB - National Institute of Biomedical Engineering, University of Porto, Porto, Portugal; Department of Nephrology, São João Hospital Center, Porto, Portugal; School of Medicine of University of Porto, Porto, Portugal.
| | - Luís Mendonça
- Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal; INEB - National Institute of Biomedical Engineering, University of Porto, Porto, Portugal; Department of Nephrology, São João Hospital Center, Porto, Portugal; School of Medicine of University of Porto, Porto, Portugal
| | - Juliana Magalhães
- Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal; INEB - National Institute of Biomedical Engineering, University of Porto, Porto, Portugal
| | - Ricardo Neto
- Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal; INEB - National Institute of Biomedical Engineering, University of Porto, Porto, Portugal; Department of Nephrology, São João Hospital Center, Porto, Portugal; School of Medicine of University of Porto, Porto, Portugal
| | - Janete Quelhas-Santos
- Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal; INEB - National Institute of Biomedical Engineering, University of Porto, Porto, Portugal; School of Medicine of University of Porto, Porto, Portugal
| | - Ana Oliveira
- Department of Nephrology, São João Hospital Center, Porto, Portugal
| | - Ana Beco
- Department of Nephrology, São João Hospital Center, Porto, Portugal
| | - João Frazão
- Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal; INEB - National Institute of Biomedical Engineering, University of Porto, Porto, Portugal; Department of Nephrology, São João Hospital Center, Porto, Portugal; School of Medicine of University of Porto, Porto, Portugal
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Sessions JW, Brust K. Calcaneal Bone Biopsy Inconsistency between Specimens Obtained From Trephine and Fine Needle Biopsy Techniques. J Foot Ankle Surg 2024; 63:241-244. [PMID: 38043599 DOI: 10.1053/j.jfas.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 10/11/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
Standardized methods for osteomyelitis (OM) diagnosis of the lower extremity have proven to be difficult. Preoperative probability of foot osteomyelitis necessitates a combination of clinical, laboratory, imaging evidence (i.e., X-ray, CT, MRI), and bone biopsy to guide diagnosis and treatment. In the recent past, the relative weight that clinicians give to these collections of data to advise potential surgical intervention has been challenged, particularly with histologic evaluation of bone biopsy-traditionally considered "gold standard" in OM diagnosis. This study seeks to further expand this dialogue by retrospectively comparing calcaneal bone biopsies performed by direct visualization trephine approach (performed by Surgeons) vs fine needle biopsy with fluoroscopy guidance (performed by Interventional Radiologists). Results obtained from 57 patients with suspected calcaneal osteomyelitis demonstrate that Trephine obtained samples are significantly more likely to produce histopathologic evidence of OM (p-value: .013), microbiologic evidence of OM (p-value: <.001) and have better histopathologic and microbiologic concordance (p-value: <.001) than calcaneal bone biopsies obtained from Fine Needle Biopsy with fluoroscopy guidance.
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Affiliation(s)
| | - Karen Brust
- Internal Medicine - Infectious Disease, University of Iowa, Iowa City, IA
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Cooke TM, Maybody M, Aly AK, Petre EN, Santos E, Noy A, Chan AY, Lis E, Gangai N, Cornelis FH, Moussa AM. Factors Affecting Diagnostic Yield of Lesional Bone Biopsy in Hematologic Malignancy Patients. Cardiovasc Intervent Radiol 2024; 47:80-86. [PMID: 37910259 DOI: 10.1007/s00270-023-03594-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE To evaluate factors affecting the diagnostic yield (percent of biopsy samples leading to a pathologic diagnosis) of lesional bone biopsies in patients with hematologic malignancies. MATERIALS AND METHODS This retrospective study included 206 lesional bone biopsies in 182 patients with a hematologic malignancy between January 2017 and December 2022. The parameters that were reviewed to evaluate diagnostic yield included biopsy device type (manual vs. electric-powered drill), number of biopsy cores acquired, core biopsy needle gauge, preliminary intra-procedural sample adequacy (touch preparation cytology determining if samples are adequate for final pathologic examination), lesion morphology on Computed Tomography (CT), and presence of crush artifact. RESULTS Review of 206 lesional biopsies showed overall diagnostic yield to be 89.8% (185/206). The two statistically significant factors affecting diagnostic yield were biopsy device type and in-room adequacy. 41/42 samples obtained with the electric-powered drill and 144/164 samples obtained using a variety of manual needles were diagnostic (97.6% vs 87.8%, p = 0.03). Of the 192 samples that were assessed for sample adequacy intra-procedurally, 97/102 of the samples that were deemed adequate were diagnostic, and 77/90 of the samples where intra-procedural adequacy was not confirmed were diagnostic (95.1% vs 85.6%, p = 0.018). The remaining factors did not affect diagnostic yield. CONCLUSION The use of an electric-powered drill bone biopsy device and intra-procedural confirmation of sample adequacy are associated with a higher diagnostic yield of lesional bone biopsies in patients with hematologic malignancies. The presence or absence of crush artifact did not significantly affect the diagnostic yield in these patients. LEVEL OF EVIDENCE IV
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Affiliation(s)
- Timothy M Cooke
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
- College of Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Majid Maybody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Ahmed K Aly
- Department of Radiology, University of Nebraska Medical Center, 981045 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Ernesto Santos
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Ariela Noy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Alexander Y Chan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Eric Lis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Amgad M Moussa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA.
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Liu J, Liu L, Li Y, Cai Z, Zhang H. Concordance of bone culture and deep tissue culture during the operation of diabetic foot osteomyelitis and clinical characteristics of patients. Eur J Trauma Emerg Surg 2023; 49:2579-2588. [PMID: 37561150 DOI: 10.1007/s00068-023-02342-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE To retrospectively analyze the concordance of bacterial culture between bone tissue and deep soft tissue in diabetic foot osteomyelitis (DFO) patients and clinical characteristics of patients. METHODS This study collected samples from 155 patients with suspected DFO (who required amputation after clinical evaluation). Bacterial culture and drug susceptibility tests were performed on the patients' deep soft tissue and bone tissue, and the consistency between the two was compared. In addition, the differences among DFO patients with different degrees of infection were compared classified by the PEDIS classifications. RESULTS Among the 155 patients diagnosed with DFO, the positive rate of bone culture was 78.7% (122/155). This study cultured 162 strains, including 73 Gram-positive bacteria, 83 Gram-negative bacteria, and 6 fungi. Staphylococcus aureus (33 strains) was the most common bacteria. The overall agreement between bone culture and tissue culture was 42.8%, with Staphylococcus aureus and Enterobacteria having the best (64.3%) and least agreements (27.3%), respectively. The drug sensitivity results in bone culture showed that Staphylococcus aureus was the main Gram-positive bacteria. The bacteria were sensitive to linezolid and vancomycin. Proteus mirabilis was the main Gram-negative bacteria. These were more sensitive than biapenem and piperacillin/tazobactam. Fungi were more sensitive to voriconazole and itraconazole. CONCLUSION The culture results of deep soft tissues near the bone cannot accurately represent the true pathogen of DFO. For DFO patients, bone culture should be taken as much as possible, and appropriate antibiotics should be selected according to the drug susceptibility results.
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Affiliation(s)
- Jiawen Liu
- Department of Endocrinology, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, No. 7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China
| | - Linlin Liu
- Department of Endocrinology, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, No. 7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China
| | - Yantao Li
- Department of Endocrinology, People's Hospital of Henan University, Henan Provincial People's Hospital, Zhengzhou, 450003, China
| | - Zixin Cai
- Department of Endocrinology, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, No. 7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China
| | - Huifeng Zhang
- Department of Endocrinology, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, No. 7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China.
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Colazo JM, Quirion J, Judice AD, Halpern J, Schwartz HS, Tanner SB, Lawrenz JM, Dahir KM, Holt GE. Utility of iliac crest tetracycline-labelled bone biopsy in osteoporosis and metabolic bone disease: An evaluation of 95 cases over a period of 25 years. Bone Rep 2023; 19:101715. [PMID: 37811524 PMCID: PMC10558706 DOI: 10.1016/j.bonr.2023.101715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
Background Metabolic bone diseases (MBD) are typically diagnosed by non-invasive imaging and clinical biomarkers. However, imaging does not provide structural information, and biomarkers can be transiently affected by many systemic factors. Bone biopsy and pathologic evaluation is the gold standard for diagnosis of MBD, however, it is rarely utilized. We describe our technique for iliac crest tetracycline-labelled bone using a cannulated drill and assess the utility of bone biopsies to provide diagnostic and therapeutic guidance. Methods In the 25-year period between March 1998 and January 2023, a total of 95 bone biopsies were performed on 94 patients for an osteological indication at Vanderbilt University Medical Center (VUMC). Patient demographics, bone biopsy indications, complications, diagnostic utility, and subsequent therapeutic guidance were retrospectively reviewed and analyzed. Results The procedure had minimal complications and was well tolerated by patients. This technique provided good quality specimens for pathology, which helped establish a diagnosis and treatment change in most patients. Patients that had biopsy-guided treatment alterations showed significant increases in Dual-Energy X-ray Absorptiometry (DEXA) bone mineral density (BMD) scores post-biopsy and subsequent treatment. Conclusion Despite scientific and technological progress in non-invasive diagnostic imaging, clinical biomarkers, and procedures for MBD, there remains a small but significant subset of patients who may benefit from inclusion of tetracycline-labelled bone biopsy into the diagnostic and therapeutic picture. Future prospective comparison studies are warranted. Mini abstract Tetracycline-labelled bone biopsies are under-utilized. Biopsy led to a histological diagnosis and ensuing treatment alteration in most patients with significant increases in bone mineral density. The biopsy procedure used herein provided good specimens with low pain/adverse events. Bone biopsy remains a valuable tool in a small, though significant, subset of patients.
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Affiliation(s)
- Juan M. Colazo
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Julia Quirion
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anthony D. Judice
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Halpern
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Herbert S. Schwartz
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - S. Bobo Tanner
- Department of Medicine, Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joshua M. Lawrenz
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathryn M. Dahir
- Department of Medicine, Division of Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ginger E. Holt
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Chaturvedy M, Maurya SK, Bajpai NK, Jangid MK, Elhence P, Elhence A, Goel AD, Sharma P, Sharma PP, Jhorawat R. Relationship between biochemical parameters of mineral bone disease and static bone histomorphometry in chronic kidney disease patients on hemodialysis: An Indian cross-section study. Nefrologia 2023; 43 Suppl 2:67-76. [PMID: 38355239 DOI: 10.1016/j.nefroe.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/23/2023] [Indexed: 02/16/2024] Open
Abstract
AIM We estimated the relationship between routine biochemical laboratory parameters with static bone histomorphometric parameters and their high and low bone turnover capacity predictability in hemodialysis patients. METHOD It was a single-center cross-sectional study, included 28 hemodialysis patients. The routine biochemical parameters measured including calcium, phosphorous, alkaline phosphatase, intact PTH, and 25-hydroxycholecalciferol. The histomorphometric parameters assessed were osteoblasts perimeter, osteoclast perimeter, eroded perimeter, osteoid perimeter, bone fibrosis and bone volume. RESULT Total 28 hemodialysis patients underwent bone biopsy. Seventy percent were male, with a mean age was 33.07±10.42 yrs; serum alkaline phosphatase was 219.10±311.3IU/ml; vitamin D was 18.18±9.56ng/ml, and intact PTH was 650.7±466.0pg/ml. Intact PTH had a significant positive association with osteoblast, osteoclast, eroded surface, and osteoid perimeter. Serum alkaline phosphatase had a significant relationship with bone fibrosis (r=0.525, p-value=0.004). Intact PTH was significantly higher in females than males (1078.75±533.04 vs. 479.6±309.83; p-value=0.004). The osteoid surface was significantly high in females compared to males (p=0.038). Age had a significant impact on osteoblast and eroded surface (p=0.008 and p=0.031, respectively). Intact PTH is a reliable biomarkers for bone turnover compare to ALP (p<0.001 and p=0.554, respectively). CONCLUSION Intact PTH strongly associated with bone formation, bone resorption parameters. Gender and age had significant impact on static histomorphometric parameters in our study.
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Affiliation(s)
| | | | | | | | - Poonam Elhence
- All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Abhay Elhence
- All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | | | - Praveen Sharma
- All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | | | - Rajesh Jhorawat
- All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
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Cimadamore A, Rescigno P, Conteduca V, Caliò A, Allegritti M, Calò V, Montagnani I, Lucianò R, Patruno M, Bracarda S. SIUrO best practice recommendations to optimize BRCA 1/2 gene testing from DNA extracted from bone biopsy in mCRPC patients (BRCA Optimal Bone Biopsy Procedure: BOP). Virchows Arch 2023; 483:579-589. [PMID: 37794204 DOI: 10.1007/s00428-023-03660-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/11/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023]
Abstract
The main guidelines and recommendations for the implementation of the BRCA1/2 somatic test do not focus on the clinical application of predictive testing on bone metastases, a frequent condition in metastatic prostate cancer, by analyzing the critical issues encountered by laboratory practice. Our goal is to produce a document (protocol) deriving from a multidisciplinary team approach to obtain high quality nucleic acids from biopsy of bone metastases. This document aims to compose an operational check-list of three phases: the pre-analytical phase concerns tumor cellularity, tissue processing, sample preservation (blood/FFPE), fixation and staining, but above all the decalcification process, the most critical phase because of its key role in allowing the extraction of somatic DNA with a good yield and high quality. The analytical phase involves the preparation of the libraries that can be analyzed in various NGS genetic sequencing platforms and with various bioinformatics software for the interpretation of sequence variants. Finally, the post-analytical phase that allows to report the variants of the BRCA1/2 genes in a clear and usable way to the clinician who will use these data to manage cancer therapy with PARP Inhibitors.
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Affiliation(s)
- Alessia Cimadamore
- Institute of Pathological Anatomy, Department of Medicine (DAME), University of Udine, Via Palladio 8, 33100, Udine, Italy.
| | - Pasquale Rescigno
- Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
- Candiolo Cancer Institute, FPO-IRCCS, 10060, Candiolo, Italy
| | - Vincenza Conteduca
- Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences - Policlinico Riuniti, University of Foggia, 71122, Foggia, Italy
| | - Anna Caliò
- Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Largo L. Scuro 10, 37134, Verona, Italy
| | - Massimiliano Allegritti
- Interventional radiology Unit, Azienda ospedaliera Santa Maria Terni, Viale Tristano di Joannuccio, 05100, Terni, Italy
| | - Valentina Calò
- Central Laboratory of Advanced Diagnosis and Biomedical Research, (CLADIBIOR) Policlinico Paolo Giaccone Hospital, University of Palermo, 90127, Palermo, Italy
| | - Ilaria Montagnani
- Pathology Unit, USL Toscana Centro - Ospedale San Giuseppe, Empoli, Italy
| | - Roberta Lucianò
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Margherita Patruno
- Center for Study of Heredo-Familial Tumors - IRCCS Istituto Tumori "Giovanni Paolo II,", Bari, Italy
| | - Sergio Bracarda
- Medical and Translational Oncology, Department of Oncology, Azienda Ospedaliera Santa Maria, Viale Tristano di Joannuccio, 05100, Terni, Italy
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10
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Yen C, Kaushik S, Desai SB. Image-guided percutaneous bone biopsy for pediatric osteomyelitis: correlating MRI findings, tissue pathology and culture, and effect on clinical management. Skeletal Radiol 2023; 52:39-46. [PMID: 35882659 DOI: 10.1007/s00256-022-04131-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 02/02/2023]
Abstract
Bone biopsy remains the gold standard for diagnosis of osteomyelitis while MRI results in a radiologic diagnosis that generally precedes biopsy. This study's purpose is to examine the diagnostic yield and effect of biopsy results on clinical management in children with suspected osteomyelitis and positive MRI findings. A retrospective review was performed at a tertiary care children's hospital. Search of the EMR and radiology PACS identified patients below 18 years who underwent bone biopsy with interventional radiology for osteomyelitis and had positive MRI findings for osteomyelitis prior to biopsy. Data was collected on patient demographics, MRI findings, biopsy procedural details, tissue culture, histopathology results, and clinical management before and after biopsy. Changes in management were categorized as antibiotic type/quantity, duration, or diagnosis. A total of 82 biopsies in 79 patients with suspicion for osteomyelitis and positive MRIs prior to biopsy were performed over 5 years from 2014 to 2019. All biopsies were successful and sent for tissue culture. 22/82 biopsies (27%) yielded positive cultures. Of those with tissue cultures, 16/22 (72%) resulted in change in clinical management. Of all biopsies, 18/82 (22%) resulted in a change in management (15 antibiotic, 1 duration, 2 diagnosis). The 2 changes in diagnosis included one biopsy done which was positive for cancer and a second which was found to not demonstrate osteomyelitis on histology. In the pediatric population, bone biopsy is a reasonably low morbidity procedure. However, there is a relatively low rate of positive tissue cultures even with MRI findings suspicious for osteomyelitis. Approximately 1 in 5 biopsies resulted in a change in clinical management, mostly in antibiotic selection. Bone biopsy may have a higher clinical impact in pre-specified circumstances.
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Affiliation(s)
- Christopher Yen
- Department of Radiology, Section of Interventional Radiology, Texas Children's Hospital, Houston, TX, USA
| | - Shivam Kaushik
- Rowan School of Osteopathic Medicine, 42 E Laurel Rd, Stratford, NJ, USA
| | - Sudhen B Desai
- Interventional Radiology, Division of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA.
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Goetz TG, Nair N, Shiau S, Recker RR, Lappe JM, Dempster DW, Zhou H, Zhao B, Guo X, Shen W, Nickolas TL, Kamanda-Kosseh M, Bucovsky M, Stubby J, Shane E, Cohen A. In premenopausal women with idiopathic osteoporosis, lower bone formation rate is associated with higher body fat and higher IGF-1. Osteoporos Int 2022; 33:659-672. [PMID: 34665288 PMCID: PMC9927557 DOI: 10.1007/s00198-021-06196-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
UNLABELLED We examined serum IGF-1 in premenopausal IOP, finding relationships that were opposite to those expected: higher IGF-1 was associated with lower bone formation and higher body fat, and lower BMD response to teriparatide. These paradoxical relationships between serum IGF-1, bone, and fat may contribute to the mechanism of idiopathic osteoporosis in premenopausal women. INTRODUCTION Premenopausal women with idiopathic osteoporosis (IOP) have marked deficits in bone microarchitecture but variable bone remodeling. We previously reported that those with low tissue-level bone formation rate (BFR) are less responsive to teriparatide and have higher serum IGF-1, a hormone anabolic for osteoblasts and other tissues. The IGF-1 data were unexpected because IGF-1 is low in other forms of low turnover osteoporosis-leading us to hypothesize that IGF-1 relationships are paradoxical in IOP. This study aimed to determine whether IOP women with low BFR have higher IGF-1 and paradoxical IGF-1 relationships in skeletal and non-skeletal tissues, and whether IGF-1 and the related measures predict teriparatide response. METHODS This research is an ancillary study to a 24 month clinical trial of teriparatide for IOP. Baseline assessments were related to trial outcomes: BMD, bone remodeling. SUBJECTS Premenopausal women with IOP(n = 34); bone remodeling status was defined by baseline cancellous BFR/BS on bone biopsy. MEASURES Serum IGF-1 parameters, compartmental adiposity (DXA, CT, MRI), serum hormones, and cardiovascular-risk-markers related to fat distribution. RESULTS As seen in other populations, lower BFR was associated with higher body fat and poorer teriparatide response. However, in contrast to observations in other populations, low BFR, higher body fat, and poorer teriparatide response were all related to higher IGF-1: IGF-1 Z-score was inversely related to BFR at all bone surfaces (r = - 0.39 to - 0.46; p < 0.05), directly related to central fat (p = 0.05) and leptin (p = 0.03). IGF-1 inversely related to 24 month hip BMD %change (r = - 0.46; p = 0.01). CONCLUSIONS Paradoxical IGF-1 relationships suggest that abnormal or atypical regulation of bone and fat may contribute to osteoporosis mechanisms in premenopausal IOP.
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Affiliation(s)
- T G Goetz
- Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - N Nair
- Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, NY, New York, USA
| | - S Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - R R Recker
- Department of Medicine, Creighton University Medical Center, Omaha, NE, USA
| | - J M Lappe
- Department of Medicine, Creighton University Medical Center, Omaha, NE, USA
| | - D W Dempster
- Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - H Zhou
- Regional Bone Center, Helen Hayes Hospital, West Haverstraw, NY, USA
| | - B Zhao
- Department of Radiology, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - X Guo
- Department of Radiology, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - W Shen
- Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
- Institute of Human Nutrition, Columbia University Irving Medical Center, New York, NY, USA
- Columbia Magnetic Resonance Research Center (CMRRC), Columbia University, New York, NY, USA
| | - T L Nickolas
- Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, NY, New York, USA
| | - M Kamanda-Kosseh
- Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, NY, New York, USA
| | - M Bucovsky
- Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, NY, New York, USA
| | - J Stubby
- Department of Medicine, Creighton University Medical Center, Omaha, NE, USA
| | - E Shane
- Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, NY, New York, USA
| | - A Cohen
- Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, NY, New York, USA.
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Sharma S, Gupta A. Adynamic bone disease: Revisited. Nefrologia 2022; 42:8-14. [PMID: 36153902 DOI: 10.1016/j.nefroe.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/16/2020] [Indexed: 06/16/2023] Open
Abstract
The bone and mineral disorders form an integral part of the management of a chronic kidney disease (CKD) patient. Amongst various types of bone pathologies in chronic kidney disease-mineral bone disorder (CKD-MBD), the prevalence of adynamic bone disease (ABD) is increasing. The present review discusses the updated pathophysiology, risk factors, and management of this disorder.
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Affiliation(s)
- Sonia Sharma
- Pediatric Nephrology, Max Superspeciality Hospital, Shalimar Bagh, New Delhi, India
| | - Ankur Gupta
- Department of Medicine, Whakatane Hospital, Whakatane, New Zealand.
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13
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Persichetti A, Milanetti E, Palmisano B, di Filippo A, Spica E, Donsante S, Coletta I, Venti MDS, Ippolito E, Corsi A, Riminucci M, Raimondo D. Nanostring technology on Fibrous Dysplasia bone biopsies. A pilot study suggesting different histology-related molecular profiles. Bone Rep 2021; 16:101156. [PMID: 34950753 PMCID: PMC8671863 DOI: 10.1016/j.bonr.2021.101156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 12/02/2022] Open
Abstract
Identifying the molecular networks that underlie Fibrous Dysplasia (FD) is key to understand the pathogenesis of the disease, to refine current diagnostic approaches and to develop efficacious therapies. In this study, we used the NanoString nCounter Analysis System to investigate the gene signature of a series of nine Formalin Fixed Decalcified and Paraffin-Embedded (FFDPE) bone biopsies from seven FD patients. We analyzed the expression level of 770 genes. Unsupervised clustering analysis demonstrated partitioning into two clusters with distinct patterns of gene expression. Differentially expressed genes included growth factors, components of the Wnt signaling system, interleukins and some of their cognate receptors, ephrin ligands, matrix metalloproteinases, neurotrophins and genes encoding components of the cAMP-dependent protein kinase. Interestingly, two tissue samples obtained from the same skeletal site of one patient one year apart failed to segregate in the same cluster. Retrospective histological review of the samples revealed different microscopic aspects in the two groups. The results of our pilot study suggest that the genetic signature of FD is heterogeneous and varies according to the histology and, likely, to the age of the lesion. In addition, they show that the Nanostring technology is a valuable tool for molecular translational studies on archival FFDPE material in FD and other rare bone diseases. We used the NanoString technology to analyze Formalin Fixed Decalcified Paraffin Embedded (FFDPE) Fibrous Dysplasia samples. We show that Fibrous Dysplasia lesions may have different molecular profiles consistent with its histological heterogeneity. NanoString technology is a valuable tool for molecular studies on rare bone diseases by using FFDPE archival material.
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Affiliation(s)
- Agnese Persichetti
- Department of Molecular Medicine, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Edoardo Milanetti
- Department of Physics, Piazzale Aldo Moro 5, 00185 Rome, Italy.,Center for Life Nano Science@Sapienza, Italian Institute of Technology, Viale Regina Elena 291, 00161 Rome, Italy
| | - Biagio Palmisano
- Department of Molecular Medicine, Viale Regina Elena, 324, 00161 Rome, Italy
| | | | - Emanuela Spica
- Department of Molecular Medicine, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Samantha Donsante
- Department of Molecular Medicine, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Ilenia Coletta
- Department of Molecular Medicine, Viale Regina Elena, 324, 00161 Rome, Italy
| | | | - Ernesto Ippolito
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Corsi
- Department of Molecular Medicine, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Mara Riminucci
- Department of Molecular Medicine, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Domenico Raimondo
- Department of Molecular Medicine, Viale Regina Elena, 324, 00161 Rome, Italy
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14
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Beltran-Bless A, Murshed M, Zakikhani M, Kuchuk I, Bouganim N, Robertson S, Kekre N, Vandermeer L, Li J, Addison C, Rauch F, Clemons M, Kremer R. Histomorphometric and microarchitectural analysis of bone in metastatic breast cancer patients. Bone Rep 2021; 15:101145. [PMID: 34841014 PMCID: PMC8605385 DOI: 10.1016/j.bonr.2021.101145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/09/2021] [Accepted: 10/16/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Despite widespread use of repeated doses of potent bone-targeting agents (BTA) in oncology patients, relatively little is known about their in vivo effects on bone homeostasis, bone quality, and bone architecture. Traditionally bone quality has been assessed using a trans-iliac bone biopsy with a 7 mm "Bordier" core needle. We examined the feasibility of using a 2 mm "Jamshidi™" core needle as a more practical and less invasive technique. METHODS Patients with metastatic breast cancer on BTAs were divided according to the extent of bone metastases. They were given 2 courses of tetracycline labeling and then underwent a posterior trans-iliac trephine biopsy and bone marrow aspirate. Samples were analyzed for the extent of tumor invasion and parameters of bone turnover and bone formation by histomorphometry. RESULTS Twelve patients were accrued, 1 had no bone metastases, 3 had limited bone metastases (LSM) (<3 lesions) and 7 had extensive bone metastases (ESM) (>3 lesions). Most of the primary tumors were estrogen receptor (ER)/progesterone receptor (PR) positive. The procedure was well tolerated. The sample quality was sufficient to analyze bone trabecular structure and bone turnover by histomorphometry in 11 out of 12 patients. There was a good correlation between imaging data and morphometric analysis of tumor invasion. Patients with no evidence or minimal bone metastases had no evidence of tumor invasion. Most had suppressed bone turnover and no detectable bone formation when treated with BTA. In contrast, 6 out of 7 patients with extensive bone invasion by imaging and evidence of tumor cells in the marrow had intense osteoclastic activity as measured by the number of osteoclasts. Of these 7 patients with ESM, 6 were treated with BTA with 5 showing resistance to BTA as demonstrated by the high number of osteoclasts present. 3 of these 6 patients had active bone formation. Based on osteoblast activity and bone formation, 3 out of 6 patients with ESM responded to BTA compared to all 3 with LSM. Compared to untreated patients, all patients treated with BTA showed a trend towards suppression of bone formation, as measured by tetracycline labelling. There was also a trend towards a significant difference between ESM and LSM treated with BTA, highly suggestive of resistance although limited by the small sample size. DISCUSSION Our results indicate that trans-iliac bone biopsy using a 2 mm trephine shows excellent correlation between imaging assessment of tumor invasion and tumor burden by morphometric analysis of bone tissues. In addition, our approach provides additional mechanistic information on therapeutic response to BTA supporting the current clinical understanding that the majority of patients with extensive bone involvement eventually fail to suppress bone turnover (Petrut B, et al. 2008). This suggests that antiresorptive therapies become less effective as disease progresses.
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Key Words
- BM, Bone met
- BPs, Bisphosphonates
- BTAs, Bone targeting agents
- Bone biopsy
- Bone microarchitecture
- Bone turnover
- Bone-targeted agents
- Breast cancer
- CK, Cytokeratin staining
- CM, Collagen material
- DEXA, Dual-energy X-ray absorptiometry
- ER, Estrogen receptor
- ESM, Extensive skeletal metastases
- HE, Haematoxylin and Eosin
- HER2, Human Epidermal growth factor Receptor 2
- Histomorphometry
- IDC, Invasive ductal carcinoma
- IHC, Immunohistochemistry staining
- LSM, Limited skeletal metastases
- MB, Mineralized bone
- OB, Osteoblasts
- OC, Osteoclasts
- OS, Osteoid surface
- PAM, Pamidronate
- PFA/PBS, Paraformaldehyde/phosphate buffer solution
- PR, Progesterone receptor
- QCT, Quantitative CT
- SREs, Skeletal related events
- TRAP, Tartrate-resistant acid phosphatase staining
- VKVG, von Kossa and van Gieson
- Zol, Zoledronic acid
- astasis AI, Aromatase inhibitors
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Affiliation(s)
- A. Beltran-Bless
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, The University of Ottawa, Ottawa, Canada
| | - M. Murshed
- Department of Medicine, Faculty of Dentistry, Shriners Hospital for Children, McGill University, Montreal, Canada
| | - M. Zakikhani
- Department of Medicine, Research Institute of the McGill University Health Center, Montreal, Canada
| | - I. Kuchuk
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, The University of Ottawa, Ottawa, Canada
| | - N. Bouganim
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, The University of Ottawa, Ottawa, Canada
| | - S. Robertson
- Department of Pathology, The Ottawa Hospital and the University of Ottawa, Ottawa, Canada
| | - N. Kekre
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, The University of Ottawa, Ottawa, Canada
| | - L. Vandermeer
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, The University of Ottawa, Ottawa, Canada
| | - J. Li
- Department of Medicine, Research Institute of the McGill University Health Center, Montreal, Canada
| | - C.L. Addison
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, Canada
| | - F. Rauch
- Department of Pediatric Surgery, McGill University Health Center, Montreal, Canada
| | - M. Clemons
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, The University of Ottawa, Ottawa, Canada
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, Canada
| | - R. Kremer
- Department of Medicine, Research Institute of the McGill University Health Center, Montreal, Canada
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Gehlen M, Schmidt N, Pfeifer M, Balasingam S, Schwarz-Eywill M, Maier A, Werner M, Siggelkow H. Osteoporosis Caused by Systemic Mastocytosis: Prevalence in a Cohort of 8392 Patients with Osteoporosis. Calcif Tissue Int 2021; 109:685-695. [PMID: 34223956 DOI: 10.1007/s00223-021-00887-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022]
Abstract
Indolent systemic mastocytosis (ISM) is a group of heterogenous diseases characterized by abnormal accumulation of mast cells in at least one organ. ISM can be a cause of osteoporosis. The aim of this study is to determine the prevalence, and the prognosis of ISM in a cohort of patients with osteoporosis. In this monocentric and retrospective study, patients with osteoporosis who did not receive a bone biopsy (cohort 1) and patients that subsequently received a diagnostic bone biopsy for differential diagnosis (cohort 2) are compared with patients who are diagnosed with ISM (cohort 3). A total of 8392 patients are diagnosed with osteoporosis. Out of these patients 1374 underwent a diagnostic bone biopsy resulting in 43 patients with ISM. These figures indicate that ISM is diagnosed in 0.5% of patients with osteoporosis and in 3.1% (men 5.8%) of patients who underwent bone biopsies. Patients with ISM sustained significantly more vertebral fractures in comparison to patients in cohort 2 (4.4 ± 3.6 versus 2.4 ± 2.5 vertebral fractures, p < 0.001) and women were significantly younger compared to cohort 2 (57.3 ± 12 versus 63.6 ± 12 years, p < 0.05). Only 33% showed an involvement of the skin (urticaria pigmentosa). ISM is a rare cause of osteoporosis (0.5%). However, in a subgroup of rather young male patients with osteoporosis the prevalence is more than 5%. Thus, ISM should be considered in premenopausal women and men presenting with vertebral fractures even if urticaria pigmentosa is not present.
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Affiliation(s)
- Martin Gehlen
- Clinic "DER FÜRSTENHOF", Department of Rheumatology, Osteology and Orthopaedics, Am Hylligen Born 7, 31812, Bad Pyrmont, Germany.
| | - Niels Schmidt
- Clinic "DER FÜRSTENHOF", Department of Rheumatology, Osteology and Orthopaedics, Am Hylligen Born 7, 31812, Bad Pyrmont, Germany
| | - Michael Pfeifer
- Clinic "DER FÜRSTENHOF", Department of Rheumatology, Osteology and Orthopaedics, Am Hylligen Born 7, 31812, Bad Pyrmont, Germany
| | - Subathira Balasingam
- Clinic "DER FÜRSTENHOF", Department of Rheumatology, Osteology and Orthopaedics, Am Hylligen Born 7, 31812, Bad Pyrmont, Germany
| | - Michael Schwarz-Eywill
- Clinic "DER FÜRSTENHOF", Department of Rheumatology, Osteology and Orthopaedics, Am Hylligen Born 7, 31812, Bad Pyrmont, Germany
| | - Anna Maier
- Department of Rheumatology, Sankt Josef-Stift Sendenhorst, West Gate 7, 48324, Sendenhorst, Germany
| | - Mathias Werner
- Department of Pathology, Vivantes Klinikum Friedrichshain, Landsberger Allee 49, 10249, Berlin, Germany
| | - Heide Siggelkow
- Clinic of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
- MVZ Endokrinologikum Goettingen, Von-Siebold-Str. 3, 37075, Goettingen, Germany
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16
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Lee ME, Jiang JY, Kang C, Tran VH, Le K, Loh H, Mansberg R. Solitary 18F-fluorodeoxyglucose avid spinous process cholangiocarcinoma metastasis proven on CT guided percutaneous needle bone biopsy. Radiol Case Rep 2021; 16:3798-801. [PMID: 34691343 DOI: 10.1016/j.radcr.2021.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 11/22/2022] Open
Abstract
A 65-year-old female with newly diagnosed cholangiocarcinoma was referred for a FDG PET/CT for initial staging. There was a region of moderate FDG avidity localizing to the hepatic hilum representing the primary site of malignancy. An unexpected moderately FDG avid focus was demonstrated in the spinous process of the T11 vertebra with no corresponding mass lesion seen on low dose CT and no evidence of distant metastatic disease elsewhere. A percutaneous CT guided needle bone biopsy was performed which confirmed a solitary T11 spinous process metastasis on histopathology.
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17
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Sebro R, Ashok SS. Utility of absolute apparent diffusion coefficient and chemical-shift imaging versus CT attenuation for predicting malignancy from percutaneous bone biopsies. J Med Radiat Sci 2021; 68:220-227. [PMID: 33607698 PMCID: PMC8424316 DOI: 10.1002/jmrs.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/20/2020] [Accepted: 02/03/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Bone lesions are sometimes detected on computed tomography studies, and biopsies are performed to evaluate whether these are malignant. The aim of the study is to evaluate whether chemical-shift imaging (CSI) and diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) are more informative than the CT attenuation for predicting malignancy. METHODS Retrospective analysis of 86 patients who underwent both diagnostic CT, CSI MRI and DWI MRI within 6 weeks prior to bone biopsy at a tertiary care academic institution between 01/01/2010 and 03/01/2020. The CT attenuation, signal intensity on in-phase sequences (SIIP), signal intensity on out-of-phase sequences (SIOP), signal intensity ratio (SIR = SIOP/SIIP) and the apparent diffusion coefficient (ADC) of the lesions over the region of the biopsy tract were measured. RESULTS A threshold CT attenuation of 157 Hounsfield Units (HU) had a sensitivity of 47.7%, specificity of 83.3% and area under the curve (AUC) of 0.59. A threshold ADC of 793 × 10-6 mm2 /s had a sensitivity of 75.8%, specificity of 85.7% and AUC of 0.83 to predict whether a bone biopsy would detect malignancy. A threshold SIR of 0.949 had a sensitivity of 77.8%, specificity of 77.8% and AUC of 0.81 to predict whether a bone biopsy would detect malignancy. ADC (P = 0.029) and SIR (P = 0.009) were significantly better than CT attenuation. There was no predictive difference between SIR and ADC (P = 0.742). CONCLUSIONS The CT attenuation of a lesion is a poor predictor of malignancy in bone lesions. CSI and DWI are significantly better for predicting malignancy.
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Affiliation(s)
- Ronnie Sebro
- Department of RadiologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Biostatistics, Epidemiology and InformaticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of GeneticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - S. Sharon Ashok
- Department of RadiologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Yamamoto S, Kamei S, Tomita K, Fujita C, Endo K, Hiraiwa S, Hasebe T. CT-guided bone biopsy using electron density maps from dual-energy CT. Radiol Case Rep 2021; 16:2343-2346. [PMID: 34306278 PMCID: PMC8258786 DOI: 10.1016/j.radcr.2021.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/05/2021] [Accepted: 06/06/2021] [Indexed: 10/29/2022] Open
Abstract
Computed tomography (CT) -guided bone biopsy is a diagnostic procedure performed on the musculoskeletal system with a high diagnostic yield and low complications. However, CT-guided bone biopsy has the disadvantage that it is difficult to confirm the presence of tumor cells during the biopsy procedure. Recently, the clinical benefits of dual-energy CT (DECT) over single-energy CT have been revealed. DECT can provide material decomposition images including calcium suppression images, and effective atomic number (Zeff) and electron density (ED) maps. ED maps have been reported to indicate cellularity. A 61-year-old woman with a history of breast cancer surgery was admitted to our hospital and underwent a CT-guided bone biopsy of the right ilium using ED maps. As a result, she was diagnosed with breast cancer metastases of intertrabecular bone. A comparison of ED maps with a pathological specimen revealed that high ED values occurred exclusively in the tumor area with high cellularity. This study indicates that ED maps produced using DECT may have potential utility in the accurate identification of metastases with high cellularity in bone lesions.
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Affiliation(s)
- Shota Yamamoto
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
| | - Shunsuke Kamei
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
| | - Kosuke Tomita
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
| | - Chikara Fujita
- Department of Radiological Technology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
| | - Kazuyuki Endo
- Department of Radiological Technology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
| | - Shinichiro Hiraiwa
- Department of Pathology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
| | - Terumitsu Hasebe
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
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Gramberg MCTT, Lagrand RS, Sabelis LWE, den Heijer M, de Groot V, Nieuwdorp M, Kortmann W, Sieswerda E, Peters EJG. Using a BonE BiOPsy (BeBoP) to determine the causative agent in persons with diabetes and foot osteomyelitis: study protocol for a multicentre, randomised controlled trial. Trials 2021; 22:517. [PMID: 34344428 PMCID: PMC8335883 DOI: 10.1186/s13063-021-05472-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/20/2021] [Indexed: 01/13/2023] Open
Abstract
Background Diabetic foot osteomyelitis (DFO) poses a major disease burden. It can generally be treated with long-term antibacterial therapy. International guidelines recommend to base antibacterial therapy choices on percutaneous bone biopsy culture, while in practice, therapy is frequently based on (less invasive) ulcer bed cultures. It is currently unknown if treatment outcomes of DFO differ depending on the chosen diagnostic strategy. Methods The BeBoP trial is a multicentre; randomised controlled; physician-, researcher- and subject-blinded; clinical trial comparing two diagnostic strategies in persons with DFO. Culture-directed antibacterial therapy will be based on either percutaneous bone biopsy culture results (intervention group) or ulcer bed biopsy culture results (comparison group). We will enrol 80 subjects with diabetes mellitus (≥ 18 years) and DFO, and we will use block randomisation stratified per centre to randomise them in a 1:1 allocation. The primary outcome is remission of DFO 12 months after enrolment. The secondary outcomes are the time to remission, signs of inflammation or ulceration at the primary location of infection at 6 and 12 months, microbiological and molecular profiles of culture outcomes, surgical interventions including amputation, total antibacterial therapy duration, infection-free survival days, adverse events, quality of life and survival. We will compare the outcomes by intention-to-treat and per-protocol analysis. Discussion We aim to compare clinical remission in persons with DFO treated with antibacterial therapy based on either percutaneous bone biopsy culture results or ulcer bed biopsy culture results. Trial registration Netherlands Trial Register NL 7582. Registered on 05 March 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05472-6.
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Affiliation(s)
- Meryl Cinzía Tila Tamara Gramberg
- Department of Internal Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Rimke Sabine Lagrand
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Louise Willy Elizabeth Sabelis
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Martin den Heijer
- Department of Internal Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Vincent de Groot
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Max Nieuwdorp
- Department of Internal Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Academisch Medisch Centrum, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Willemijn Kortmann
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, Alkmaar, The Netherlands
| | - Elske Sieswerda
- Department of Medical Microbiology, Medical Cemtre Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - Edgar Josephus Gerardus Peters
- Department of Internal Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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20
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Uhl M, Herget G, Hettmer S, von Kalle T. [Bone and soft tissue tumours in children : Proposal for a rational diagnostic approach]. Radiologe 2021; 61:649-657. [PMID: 34100121 DOI: 10.1007/s00117-021-00859-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Abstract
CLINICAL/METHODOLOGICAL ISSUE Bone and soft tissue tumours are often incidental findings in children. Because they are usually benign tumours, nonspecialised radiologists generally have little experience in the diagnosis and differentiation from malignant tumours. Various imaging techniques are used in the diagnosis of skeletal tumours. STANDARD RADIOLOGICAL METHODS Imaging techniques used to evaluate bone and soft tissue tumours include sonography, computed tomography (CT) and magnetic resonance imaging (MRI). METHODOLOGICAL INNOVATIONS An algorithm to determine malignancy of bone and soft tissue tumours in children is proposed. PERFORMANCE By using the presented algorithms, further diagnostic procedures such as biopsies can be avoided in the majority of children with bone and soft tissue tumours. Aggressive bone lesions and unclear soft tissue tumours are guided to biopsy to confirm diagnosis. ACHIEVEMENTS The algorithms presented are based on the proposals of European professional societies and have been adapted by the authors for use in children and adolescents. PRACTICAL RECOMMENDATIONS In the clarification of soft tissue tumours, sonography is the first diagnostic tool; depending on the sonographic findings, MRI is the technique for further clarification. Biopsy confirmation of the diagnosis in unclear cases or in cases of probable malignancy should be carried out in a paediatric oncology centre.
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Affiliation(s)
- M Uhl
- Klinik für Diagnostische und Interventionelle Radiologie, Kinderradiologie und Neuroradiologie, Artemed Klinikum Freiburg, Sautierstr. 1, 79104, Freiburg, Deutschland.
| | - G Herget
- Klinik für Orthopädie und Unfallchirurgie, Tumorsprechstunde, Comprehensive Cancer Center Freiburg CCCF, Medizinische Fakultät, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - S Hettmer
- Universitätskinderklinik ZKJ, Pädiatrische Onkologie und Hämatologie, Sarkomzentrum am Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - T von Kalle
- Radiologisches Institut, Olgahospital Klinikum Stuttgart, Stuttgart, Deutschland
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21
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Morris R, Shepherd K, Cribb G, Singh J, Tyrrell P, Cool P. Bone biopsy results in patients with a history of malignancy: a case series of 378 patients. Skeletal Radiol 2021; 50:1111-1116. [PMID: 33097964 DOI: 10.1007/s00256-020-03652-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The value of a bone biopsy in patients who present with a bone lesion and past medical history of malignancy is uncertain. The objective of this study was to evaluate the outcome of bone biopsies in patients with a history of a malignancy undergoing bone biopsy of a lesion in a regional bone tumour unit. Secondary outcomes include the assessment of survival in the different outcome groups. MATERIALS AND METHODS This was a retrospective study of patients, with a previous malignancy and suspicious bone lesions, who underwent bone biopsy for final diagnosis between March 2010 and September 2019. Results of the biopsy were summarized into 3 groups: confirmed original malignancy, confirmed benign diagnosis, and confirmed new malignancy. Survival analysis of each group was also undertaken. RESULTS A total of 378 patients met the inclusion criteria (mean age 64 years, 216 females (57%)). In 250 cases (66%), the original malignancy was confirmed on the bone biopsy; in 128 cases, an alternative diagnosis was confirmed (benign diagnosis in 69 (18%)), and 59 had a new malignancy (16%). Survival was significantly greater for those in whom a benign diagnosis was confirmed (logrank test p = 0.0100). CONCLUSION This study shows that for patients presenting with a suspicious bone lesion, together with a history of malignancy, in a third of cases, the bone biopsy will confirm an alternative diagnosis of a benign lesion or a new malignancy. Survival of these patients will vary significantly depending on the biopsy outcome.
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Affiliation(s)
- Rhys Morris
- Montgomery Unit, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK.
| | - Karen Shepherd
- Montgomery Unit, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK
| | - Gillian Cribb
- Montgomery Unit, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK
| | - Jaspreet Singh
- Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK
| | - Prudencia Tyrrell
- Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK
| | - Paul Cool
- Montgomery Unit, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK.,Keele University, Newcastle, Staffordshire, ST5 5BG, UK
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22
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Kawamura R, Suzuki Y, Harada Y, Shimizu T. Atypical presentation of colorectal carcinoma with sole multiple osteolytic bone metastases: a case report. J Med Case Rep 2021; 15:256. [PMID: 34016176 PMCID: PMC8139034 DOI: 10.1186/s13256-021-02795-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/16/2021] [Indexed: 11/20/2022] Open
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 patients 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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Affiliation(s)
- Ren Kawamura
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, 321-0293, Japan
| | - Yudai Suzuki
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, 321-0293, Japan
| | - Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, 321-0293, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, 321-0293, Japan.
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Lotz M, Schumacher C, Stadlinger B, Ikenberg K, Rücker M, Valdec S. Accuracy of guided biopsy of the jawbone in a clinical setting: A retrospective analysis. J Craniomaxillofac Surg 2021; 49:556-561. [PMID: 33726950 DOI: 10.1016/j.jcms.2021.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/18/2021] [Accepted: 02/20/2021] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to investigate the accuracy of a previously described technique for guided biopsy of osseous pathologies of the jawbone in a clinical setting. The data sets of patients who had undergone guided biopsy procedures were retrospectively examined for accuracy. Digital planning of the biopsies and manufacturing of the tooth-supported drilling template were performed with superimposed cone beam computed tomography and intraoral scans using implant planning software. After a trephine biopsy was taken using the template, the postoperative low-dose cone beam computed tomography was analyzed for accuracy using the planning software with the corresponding (digitally-planned) biopsy cylinder. The mean angular deviation was 4.35 ± 2.5°. The mean depth deviation was -1.40 ± 1.41 mm. Guided biopsy seems to be an alternative to a conventional approach for minimally invasive and highly accurate jawbone biopsy.
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Affiliation(s)
- Martin Lotz
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.
| | - Caterina Schumacher
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Kristian Ikenberg
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Martin Rücker
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Silvio Valdec
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
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24
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Sharma S, Gupta A. Adynamic bone disease: Revisited. Nefrologia 2021; 42:S0211-6995(21)00025-4. [PMID: 33707096 DOI: 10.1016/j.nefro.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022] Open
Abstract
The bone and mineral disorders form an integral part of the management of a chronic kidney disease (CKD) patient. Amongst various types of bone pathologies in chronic kidney disease-mineral bone disorder (CKD-MBD), the prevalence of adynamic bone disease (ABD) is increasing. The present review discusses the updated pathophysiology, risk factors, and management of this disorder.
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Affiliation(s)
- Sonia Sharma
- Pediatric Nephrology, Max Superspeciality Hospital, Shalimar Bagh, New Delhi, India
| | - Ankur Gupta
- Department of Medicine, Whakatane Hospital, Whakatane, New Zealand.
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25
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Gandbhir VN, Dussa K, Kakadiya G, K.K. N, Parekh A. Retrieval of broken bone biopsy needle from the sacroiliac joint - A case report and review of literature. Trauma Case Rep 2021; 31:100395. [PMID: 33490358 PMCID: PMC7811160 DOI: 10.1016/j.tcr.2020.100395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2020] [Indexed: 11/24/2022] Open
Abstract
Bone biopsies whether Computed Tomography guided or open, are one of the commonest procedures undertaken. Our literature review proves that bone biopsy needle fracture in a bone is a rare complication with no literature available on a needle fracture in a joint. We report a 7-year-old male who underwent an open needle biopsy. During the procedure, the bone biopsy needle fractured with the distal 2.7 cm fragment being completely embedded in the right sacroiliac joint. Considering the location of the fragment, the standard techniques described in literature for extraction could not be applied due to intra-articular nature of the fragment and the risk of complications. We describe a method using a 2.5 mm drill bit to safely extract the foreign body. We have found that reasonable erosion of adjacent cortex, exposes the needle tip, prevents the needle from shattering and avoids further articular damage. There was an uneventful 15 months follow up. This case highlights the fact that bone biopsy procedure mandates correct technique and supervision and as far as possible a disposable pre-sterilized bone biopsy needle should be used.
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Affiliation(s)
- Viraj N. Gandbhir
- Corresponding author at: 92, Bhaskar Parshuram Niketan, Sakharam Keer Road, Mahim, Mumbai Postal code - 400016, India.
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26
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Farrell M, Hyun G, Goold MP, Krapiva P. A case series on the role of 18F-FDG PET/CT-guided biopsy of osseous metastases. Eur J Hybrid Imaging 2021; 5:1. [PMID: 34181113 PMCID: PMC8218035 DOI: 10.1186/s41824-021-00095-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose This case series explores the utility of positron emission tomography (PET)/computed tomography (CT) guidance for biopsy of 18F-fludeoxyglucose (FDG)-avid osseous lesions that are inconspicuous on CT. Methods PET/CT-guided core biopsies were performed in four patients with suspected malignancies given 18F-FDG-avid osseous lesions that were inconspicuous on CT alone. The final diagnosis for each patient was determined by histopathological and molecular testing. Results PET/CT-guided biopsy yielded accurate sampling via core needle biopsy (CNB) with histopathological confirmation of osseous metastases of the primary malignancy as opposed to a secondary malignancy in three patients and ruled-out metastatic spread in the fourth. Conclusion PET/CT-guided biopsy of hypermetabolic osseous lesions that are inconspicuous on CT alone is an effective and safe diagnostic tool in patients with suspected malignancy. Supplementary Information The online version contains supplementary material available at 10.1186/s41824-021-00095-1.
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Affiliation(s)
- Michael Farrell
- Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | - Gina Hyun
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Michael P Goold
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Pavel Krapiva
- Walter Reed National Military Medical Center, Bethesda, MD, USA
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27
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Salam S, Gallagher O, Hughes D, Khwaja A, Eastell R. The role of static bone histomorphometry in diagnosing renal osteodystrophy. Bone 2021; 142:115689. [PMID: 33065356 DOI: 10.1016/j.bone.2020.115689] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/23/2020] [Accepted: 10/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bone biopsy is the gold standard test to diagnose renal osteodystrophy (ROD). There is a preference to perform bone biopsy during renal transplantation but tetracycline bone labelling is usually not possible. We aimed to test if histomorphometry static parameters can identify low and high bone turnover as assessed by dynamic measurement using double tetracycline labelling. METHODS 43 CKD stages 4-5D had trans-iliac bone biopsy using a 4 mm Jamshidi trephine and needle after tetracycline labelling. Quantitative histomorphometry was performed using the Bioquant Osteo histomorphometry system. Normal bone turnover was defined as bone formation rate/bone surface (BFR/BS) of 18-38 μm3/μm2/year. Static parameters of bone turnover included osteoblast surface/bone surface (Ob.S/BS, %), osteoclast surface/bone surface (Oc.S/BS, %) and erosion surface/bone surface (ES/BS, %). Receiver operating characteristics (ROC) analysis was used to evaluate diagnostic accuracy of these static parameters for low and high bone turnover (based on BFR/BS). RESULTS Median (IQR) for BFR/BS in this study was 32.12 (17.76-48.25) μm3/μm2/year. 26% of patients had low, 34% had normal and 40% had high bone turnover. The area under the ROC curve (AUC) for Ob.S/BS, Oc.S/BS and ES/BS were non-significant indicating poor accuracy for identifying low bone turnover. The AUC for Ob.S/BS was 0.697 (95% CI 0.538 to 0.827) indicating fair accuracy for identifying high bone turnover. Oc.S/BS and ES/BS had non-significant AUCs for high bone turnover. CONCLUSIONS Static histomorphometry parameters for bone turnover are unable to replace dynamic parameter in diagnosing ROD. Tetracycline bone labelling is still required.
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Affiliation(s)
- Syazrah Salam
- Sheffield Kidney Institute, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom; Department of Oncology and Metabolism, Mellanby Centre for Bone Research, University of Sheffield, United Kingdom.
| | - Orla Gallagher
- Department of Oncology and Metabolism, Mellanby Centre for Bone Research, University of Sheffield, United Kingdom
| | - David Hughes
- Department of Oncology and Metabolism, Mellanby Centre for Bone Research, University of Sheffield, United Kingdom; Histopathology Department, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - Arif Khwaja
- Sheffield Kidney Institute, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - Richard Eastell
- Department of Oncology and Metabolism, Mellanby Centre for Bone Research, University of Sheffield, United Kingdom
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Mais DD, Hackman S, Ross J. Histopathologic findings in culture-positive secondary osteomyelitis. Ann Diagn Pathol 2020; 50:151661. [PMID: 33197866 DOI: 10.1016/j.anndiagpath.2020.151661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022]
Abstract
As peripheral vascular disease and diabetes mellitus are increasingly common, chronic wounds are often seen. Bone biopsies, with imaging and microbial cultures, are often obtained to evaluate for osteomyelitis. Because much of the historical literature describing the histology of osteomyelitis pertains to primary osteomyelitis, this study characterizes the histologic findings and provides correlation with culture results in secondary osteomyelitis. The histologic features of bone biopsies were assessed over a 5 year period. Concurrent laboratory and radiographic data were obtained and these data were compared with culture results. This study included 163 cases, of which 104 were culture-positive osteomyelitis. All culture-positive cases had been present longer than 28 days and had at least one of the following histologic features: neutrophilic inflammation, plasmacytic inflammation, or eosinophilic fibrosis. However, none of these findings were restricted to culture-positive cases. Overall, plasmacytic and neutrophilic inflammation provided similar specificity, and positive predictive values for osteomyelitis. Medullary fibrosis gave a sensitivity of 95%, the highest for any single feature, and the combination of fibrosis and neutrophilic inflammation had the greatest specificity of 96%. Additionally, neutrophilic inflammation correlated often with isolation of Staphylococcus aureus, while plasma cell predominance was found more frequently with other infectious agents. This study describes histologic features in secondary osteomyelitis, which may challenge the widespread inclination to equate a neutrophilic inflammation with 'acute osteomyelitis' and 'chronic osteomyelitis' with one rich in plasma cells. We report an early correlation between common histopathologic findings and specific culture isolates, which can be further refined with additional research.
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Affiliation(s)
- Daniel D Mais
- UT-Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Sarah Hackman
- UT-Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - Jenny Ross
- UT-Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
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29
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Tawfik GM, Dibas M, Dung NM, Alkhebairy AA, Mahmoud MH, Ibrahim MH, Abd Elhady NR, Sayed AM, Gehad AS, Abdelrahman AS, Elfaituri MK, Nam NH, El-Qushayri AE, Huy NT. Concordance of bone and non-bone specimens in microbiological diagnosis of osteomyelitis: A systematic review and meta-analysis. J Infect Public Health 2020; 13:1682-1693. [PMID: 32962953 DOI: 10.1016/j.jiph.2020.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 08/16/2020] [Accepted: 08/23/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The diagnosis of osteomyelitis is invasive and expensive as the current standard technique is the bone biopsy. Our aim was to compare the degree of agreement and concordance between standard bone biopsy and other non-bone techniques. METHODS We performed an electronic search through 12 electronic databases to retrieve relevant studeis. Our criteria included any original article that reported the degree of agreement and/or the concordance between bone biopsy and other non-bone techniques in diagnosing osteomyelitis. We published our protocol in PROSPERO with a registration number, CRD42017080336. RESULTS There were 29 studies included in the qualitative analysis, of which 15 studies were included in the meta-analysis. Samples from sinus tract had the highest concordance with bone biopsy samples, while swab samples were the least concordant with bone biopsy samples. Additionally, Staphylococcus aureus was the most common bacteria isolated and the most concordant from samples, compared to other types of causative agents. Sinus tract had a significantly very high degree of agreement with bone samples. S. aureus had the highest degree of agreement in bone smaples. CONCLUSION Diagnosis of osteomyelitis using sinus tract swab is close in results' accuracy to bone biopsy. S. aureus was the most common extracted organism found in these samples and had the highest degree of agreement.
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Affiliation(s)
- Gehad Mohamed Tawfik
- Faculty of Medicine, Ain Shams University, Cairo, Egypt; Online Research Club (www.onlineresearchclub.org).
| | - Mahmoud Dibas
- Online Research Club (www.onlineresearchclub.org); Sulaiman Al Rajhi Colleges, College of Medicine, Saudi Arabia.
| | - Nguyen Minh Dung
- Online Research Club (www.onlineresearchclub.org); Department of Sport Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, 70000, Viet Nam.
| | - Ahmad Awad Alkhebairy
- Online Research Club (www.onlineresearchclub.org); Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
| | - Mona Hanafy Mahmoud
- Faculty of Medicine, Ain Shams University, Cairo, Egypt; Online Research Club (www.onlineresearchclub.org).
| | - Mohamed Hosny Ibrahim
- Faculty of Medicine, Ain Shams University, Cairo, Egypt; Online Research Club (www.onlineresearchclub.org).
| | - Nada Ramadan Abd Elhady
- Online Research Club (www.onlineresearchclub.org); Faculty of Medicine, Fayoum University, Fayoum, Egypt.
| | - Ahmed M Sayed
- Online Research Club (www.onlineresearchclub.org); Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt.
| | - Ahmed Samir Gehad
- Online Research Club (www.onlineresearchclub.org); Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Ahmed Saber Abdelrahman
- Online Research Club (www.onlineresearchclub.org); Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt.
| | - Muhammed Khaled Elfaituri
- Online Research Club (www.onlineresearchclub.org); Faculty of Medicine, University of Tripoli, Tripoli, Libya.
| | - Nguyen Hai Nam
- Online Research Club (www.onlineresearchclub.org); Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, 70000, Viet Nam.
| | - Amr Ehab El-Qushayri
- Online Research Club (www.onlineresearchclub.org); Faculty of Medicine, Minia University, Minia, 61519, Egypt.
| | - Nguyen Tien Huy
- Evidence Based Medicine Research Group, Ton Duc Thang University, Ho Chi Minh City, 70000, Viet Nam; Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, 70000, Viet Nam.
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Novel-Catin E, Pelletier S, Fouque D, Roux JP, Chapurlat R, D'Haese P, Behets G, Evenepoel P, Nickolas TL, Lafage-Proust MH. Quantitative histomorphometric analysis of halved iliac crest bone biopsies yield comparable ROD diagnosis as full 7.5mm wide samples. Bone 2020; 138:115460. [PMID: 32485361 DOI: 10.1016/j.bone.2020.115460] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Histomorphometric analysis of a transiliac bone biopsy is the gold standard for the diagnosis of renal osteodystrophy (ROD). This procedure is costly, invasive and usually performed with a trephine with an internal diameter of 7.5 mm. Our objective was to evaluate the accuracy of ROD diagnosis on halved histological bone sections to determine if they are comparable to the standard 7.5 mm samples. DESIGN We included 68 bone biopsies performed in CKD patients for diagnostic purposes with a 7.5 mm diameter trephine. Quantitative histomorphometric analysis of the whole bone samples was performed including assessment of bone mineralization, turnover and volume. Each histological section (representing the whole 7.5 mm diameter biopsy) was then divided lengthwise in two hemisections (representing the 3.5 mm diameter biopsy). Histomorphometric analysis was repeated this time on the two hemibiopsies for each sample, blinded from initial results. Diagnoses were classified as osteitis fibrosa, adynamic bone disease, mixed uremic bone disease, osteomalacia or other. Correlations between the whole sample and the hemibiopsies for each parameter were studied. Concordance between the various bone parameters and final ROD diagnosis obtained from the whole section versus the two hemi sections was evaluated. RESULTS Highly significant correlations were found between parameters measured on the whole section and the corresponding hemisections, with r coefficient of 0.98 for osteoid surface and thickness and bone formation rate, 0.97 for osteoclast surface, and 0.96 for bone volume (p < 0.001). Final diagnosis was in full accordance between the whole biopsy and the two corresponding hemi-biopsies in 91% of cases. CONCLUSIONS Accurate diagnosis of ROD type was obtained by evaluation of bone surface areas of 3 mm diameter. These data suggest that small invasive bone biopsies might provide accurate ROD diagnostics while decreasing both invasiveness and cost of the procedure.
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Affiliation(s)
- Etienne Novel-Catin
- INSERM U1059 and University Hospital, Saint-Etienne, France; Université de Lyon, Lyon, France; Department of Nephrology, University Hospital - Lyon Sud, France.
| | | | - Denis Fouque
- Université de Lyon, Lyon, France; Department of Nephrology, University Hospital - Lyon Sud, France.
| | - Jean-Paul Roux
- Université de Lyon, Lyon, France; INSERM UMR 1033, Lyon Cedex 08, France.
| | - Roland Chapurlat
- Université de Lyon, Lyon, France; INSERM UMR 1033, Lyon Cedex 08, France.
| | - Patrick D'Haese
- Laboratory of Pathophysiology, University of Antwerp, Wilrijk, Belgium.
| | - Geert Behets
- Laboratory of Pathophysiology, University of Antwerp, Wilrijk, Belgium.
| | - Peter Evenepoel
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Nephrology, Belgium.
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Soeiro EMD, Castro L, Menezes R, Elias RM, Dos Reis LM, Jorgetti V, Moysés RMA. Association of parathormone and alkaline phosphatase with bone turnover and mineralization in children with CKD on dialysis: effect of age, gender, and race. Pediatr Nephrol 2020; 35:1297-1305. [PMID: 32157445 DOI: 10.1007/s00467-020-04499-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Studies investigating bone histology in children with chronic kidney disease (CKD) are scarce. METHODS Forty-two patients, mean age 11.3 ± 4.3 years with stage 5 CKD on dialysis, underwent double tetracycline labeling bone biopsy and the relationship between clinical features, biochemical markers, and bone densitometry (DXA) was investigated. RESULTS Low bone turnover was present in 59% of patients, abnormal mineralization in 29%, and low bone volume in 7%. Higher bone formation rate was found in non-Caucasian patients, whereas abnormal mineralization occurred in older and shorter children. We found no impact of gender and etiology of renal disease in our population. Parathormone (PTH) and alkaline phosphatase (AP) showed positive associations with bone turnover. ROC curve analysis showed a fair performance of biomarkers to predict TMV status. PTH < 2 times ULN independently associated with low bone turnover (RR 5.62, 95% CI 1.01-31.24; p = 0.049), in a model adjusted for race, calcitriol dosage, and calcium. It was also associated with abnormal mineralization (RR 1.35, 95% CI 1.04-1.75; p = 0.025), in a model adjusted for BMD scores, AP, age, and calcitriol. PTH and AP significantly predicted turnover and mineralization defect, although with low specificity and sensitivity, reaching a maximum value of 64% and 67%, respectively. CONCLUSIONS While PTH and AP were associated with turnover and mineralization, we recognize the limitation of their performance to clearly distinguish high from low/normal bone turnover and normal from abnormal mineralization. Our results reinforce the need to expand knowledge about renal osteodystrophy in pediatric population through prospective bone biopsy studies. Graphical abstract.
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Affiliation(s)
- Emilia M D Soeiro
- Laboratório de Investigação Médica 16, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Faculdade Pernambucana de Saúde, Recife, Brazil.,Instituto de Medicina Integral de Pernambuco, Recife, Brazil
| | | | | | - Rosilene M Elias
- Laboratório de Investigação Médica 16, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luciene M Dos Reis
- Laboratório de Investigação Médica 16, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vanda Jorgetti
- Laboratório de Investigação Médica 16, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Rosa M A Moysés
- Laboratório de Investigação Médica 16, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. .,LIM 16-Nephrology Department, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3342, São Paulo, SP, 01246-903, Brazil.
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Gallo D, Rosetti S, Marcon I, Armiraglio E, Parafioriti A, Pinotti G, Perrucchini G, Patera B, Gentile L, Tanda ML, Bartalena L, Piantanida E. When primary hyperparathyroidism comes as good news. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200046. [PMID: 32554826 PMCID: PMC7354736 DOI: 10.1530/edm-20-0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/15/2020] [Indexed: 12/14/2022] Open
Abstract
SUMMARY Brown tumors are osteoclastic, benign lesions characterized by fibrotic stroma, intense vascularization and multinucleated giant cells. They are the terminal expression of the bone remodelling process occurring in advanced hyperparathyroidism. Nowadays, due to earlier diagnosis, primary hyperparathyroidism keeps few of the classical manifestations and brown tumors are definitely unexpected. Thus, it may happen that they are misdiagnosed as primary or metastatic bone cancer. Besides bone imaging, endocrine evaluation including measurement of serum parathyroid hormone and calcium (Ca) levels supports the pathologist to address the diagnosis. Herein, a case of multiple large brown tumors misdiagnosed as a non-treatable osteosarcoma is described, with special regards to diagnostic work-up. After selective parathyroidectomy, treatment with denosumab was initiated and a regular follow-up was established. The central role of multidisciplinary approach involving pathologist, endocrinologist and oncologist in the diagnostic and therapeutic work-up is reported. In our opinion, the discussion of this case would be functional especially for clinicians and pathologists not used to the differential diagnosis in uncommon bone disorders. LEARNING POINTS Brown tumors develop during the remodelling process of bone in advanced and long-lasting primary or secondary hyperparathyroidism. Although rare, they should be considered during the challenging diagnostic work-up of giant cell lesions. Coexistence of high parathyroid hormone levels and hypercalcemia in primary hyperparathyroidism is crucial for the diagnosis. A detailed imaging study includes bone X-ray, bone scintiscan and total body CT; to rule out bone malignancy, evaluation of bone lesion biopsy should include immunostaining for neoplastic markers as H3G34W and Ki67 index. If primary hyperparathyroidism is confirmed, selective parathyroidectomy is the first-line treatment. In advanced bone disease, treatment with denosumab should be considered, ensuring a strict control of Ca levels.
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Affiliation(s)
- Daniela Gallo
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, Varese, Italy
| | - Sara Rosetti
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, Varese, Italy
| | - Ilaria Marcon
- Department of Oncology, ASST dei Sette Laghi, Varese, Italy
| | - Elisabetta Armiraglio
- Pathology Unit, ASST Gaetano Pini, Centro Specialistico Ortopedico Traumatologico, Gaetano Pini-CTO, Milano, Italy
| | - Antonina Parafioriti
- Pathology Unit, ASST Gaetano Pini, Centro Specialistico Ortopedico Traumatologico, Gaetano Pini-CTO, Milano, Italy
| | | | | | - Bohdan Patera
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, Varese, Italy
| | - Linda Gentile
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, Varese, Italy
| | - Maria Laura Tanda
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, Varese, Italy
| | - Luigi Bartalena
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, Varese, Italy
| | - Eliana Piantanida
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, Varese, Italy
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Aaltonen L, Koivuviita N, Seppänen M, Tong X, Kröger H, Löyttyniemi E, Metsärinne K. Correlation between 18F-Sodium Fluoride positron emission tomography and bone histomorphometry in dialysis patients. Bone 2020; 134:115267. [PMID: 32058018 DOI: 10.1016/j.bone.2020.115267] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/03/2020] [Accepted: 02/09/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The diagnosis of renal osteodystrophy is challenging. Bone biopsy is the gold standard, but it is invasive and limited to one site of the skeleton. The ability of biomarkers to estimate the underlying bone pathology is limited. 18F-Sodium Fluoride positron emission tomography (18F-NaF PET) is a noninvasive quantitative imaging technique that allows assessment of regional bone turnover at clinically relevant sites. The hypothesis of this study was, that 18F-NaF PET correlates with bone histomorphometry in dialysis patients and could act as a noninvasive diagnostic tool in this patient group. METHODS This was a cross-sectional diagnostic test study. 26 dialysis patients with biochemical abnormalities indicating mineral and bone disorder were included. All the participants underwent a 18F-NaF PET scan and a bone biopsy. Fluoride activity in the PET scan was measured in the lumbar spine and at the anterior iliac crest. Dynamic and static histomorphometric parameters of the bone biopsy were assessed. As histomorphometric markers for bone turnover we used bone formation rate per bone surface (BFR/BS) and activation frequency per year (Ac.f). RESULTS There was a statistically significant correlation between fluoride activity in the 18F-NaF PET scan and histomorphometric parameters such as bone formation rate, activation frequency and osteoclast and osteoblast surfaces and mineralized surfaces. 18F-NaF PET's sensitivity to recognize low turnover in respect to non-low turnover was 76% and specificity 78%. Because of the small number of patients with high turnover, we were unable to demonstrate significant predictive value in this group. CONCLUSIONS A clear correlation between histomorphometric parameters and fluoride activity in the 18F-NaF PET scan was established. 18F-NaF PET may possibly be a noninvasive diagnostic tool in dialysis patients with low turnover bone disease, but further research is needed.
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Affiliation(s)
- Louise Aaltonen
- Kidney Center, Department of Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, Turku 20521, Finland.
| | - Niina Koivuviita
- Kidney Center, Department of Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, Turku 20521, Finland
| | - Marko Seppänen
- Department of Clinical Physiology, Nuclear Medicine and Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, Turku 20521, Finland
| | - Xiaoyu Tong
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, POB 1627, Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, POB 1627, Kuopio, Finland; Kuopio University Hospital, Kuopio, Finland
| | - Eliisa Löyttyniemi
- Department of Biostatistics, University of Turku, Kiinamyllynkatu 10, 20014 Turku, Finland
| | - Kaj Metsärinne
- Kidney Center, Department of Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, Turku 20521, Finland
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Hamidi S, Mottard S, Berthiaume MJ, Doyon J, Bégin MJ, Bondaz L. Brown tumor of the iliac crest initially misdiagnosed as a giant cell tumor of the bone. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200029. [PMID: 32478667 PMCID: PMC7219131 DOI: 10.1530/edm-20-0029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/23/2020] [Indexed: 12/04/2022] Open
Abstract
SUMMARY Brown tumors (BTs) are expansile osteolytic lesions complicating severe primary hyperparathyroidism (PHPT). Clinical, radiological and histological features of BTs share many similarities with other giant cell-containing lesions of the bone, which can make their diagnosis challenging. We report the case of a 32-year-old man in whom an aggressive osteolytic lesion of the iliac crest was initially diagnosed as a giant cell tumor by biopsy. The patient was scheduled for surgical curettage, with a course of neoadjuvant denosumab. Routine biochemical workup prior to denosumab administration incidentally revealed high serum calcium levels. The patient was diagnosed with PHPT and a parathyroid adenoma was identified. In light of these findings, histological slices of the iliac lesion were reviewed and diagnosis of a BT was confirmed. Follow-up CT-scans performed 2 and 7 months after parathyroidectomy showed regression and re-ossification of the bone lesion. The aim of this case report is to underline the importance of distinguishing BTs from other giant cell-containing lesions of the bone and to highlight the relevance of measuring serum calcium as part of the initial evaluation of osteolytic bone lesions. This can have a major impact on patients' management and can prevent unnecessary invasive surgical interventions. LEARNING POINTS Although rare, brown tumors should always be considered in the differential diagnosis of osteolytic giant cell-containing bone lesions. Among giant cell-containing lesions of the bone, the main differential diagnoses of brown tumors are giant cell tumors and aneurysmal bone cysts. Clinical, radiological and histological characteristics can be non-discriminating between brown tumors and giant cell tumors. One of the best ways to distinguish these two diagnoses appears to be through biochemical workup. Differentiating brown tumors from giant cell tumors and aneurysmal bone cysts is crucial in order to ensure better patient care and prevent unnecessary morbid surgical interventions.
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Affiliation(s)
- S Hamidi
- Division of Endocrinology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - S Mottard
- Division of Orthopedic Surgery, Department of Surgery, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - M J Berthiaume
- Department of Radiology, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - J Doyon
- Department of Pathology, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - M J Bégin
- Division of Endocrinology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - L Bondaz
- Division of Endocrinology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Montréal, Canada
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Gaspari V, Mazza L, Pinto D, Raone B, Calogero P, Patrizi A. Syphilis as osteomyelitis of the fifth metatarsal of the left foot: the great imitator hits once again. Int J Infect Dis 2020; 96:10-11. [PMID: 32289561 DOI: 10.1016/j.ijid.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION We report an unusual case of osteomyelitis of the left foot due to syphilitic bone involvement. CASE PRESENTATION A 73-year-old man came to our attention with a four-month history of fever and a hypertrophic ulceration of the fifth metatarsal of the left foot. He had a history of syphilis treated years before. The CT scan showed an evident osteolytic area of the metatarsal phalangeal joint of the fifth left toe. The serological tests demonstrated a syphilitic reinfection. On suspicion of a bone localization of syphilis, an US-guided bone biopsy was performed. The histological examination with silver impregnation confirmed the diagnosis. The patient was treated with the traditional treatment of syphilis using penicillin, obtaining the complete resolution of the radiological and cutaneous alterations. CONCLUSIONS The aim of this work is to sensitize clinicians to suspect syphilis in case of osteolytic lesions in patients with a history of this disease.
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Affiliation(s)
- Valeria Gaspari
- Dermatology Unit, Head and Neck Department, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Liliana Mazza
- Acute Geriatric Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Daniela Pinto
- Acute Geriatric Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Beatrice Raone
- Dermatology Unit, Head and Neck Department, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Pietro Calogero
- Acute Geriatric Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology Unit, Head and Neck Department, S.Orsola-Malpighi University Hospital, Bologna, Italy
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Bouvard B, Pascaretti-Grizon F, Legrand E, Lavigne C, Audran M, Chappard D. Bone lesions in systemic mastocytosis: Bone histomorphometry and histopathological mechanisms. Morphologie 2020; 104:97-108. [PMID: 32127247 DOI: 10.1016/j.morpho.2020.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 01/06/2023]
Abstract
Osteoporosis is considered the most frequent skeletal manifestation of systemic mastocytosis (SM). We performed a retrospective analysis of sixty patients (37 males and 23 females) who underwent a bone biopsy in the assessment of SM or in the assessment of unexplained bone fragility. Thirty-three had simultaneously a bone marrow biopsy with a Jamshidi's needle; this sample was used for immunohistochemical analysis (tryptase, c-KIT. CD20, VCAM-1). Bone biopsy was realized in 42 cases in the assessment of SM to provide histologic proof of the disease and in 18 cases in the assessment of unexplained bone fragility and surprisingly revealed a SM. An increased bone turnover was observed in patients with SM with elevated eroded surfaces, osteoclast number and bone formation rate. In addition to nodules of mast cells (MC), a high number of MC was directly apposed on the trabeculae, affixed on the osteoblasts or the lining cells. The VCAM-1 adhesion protein recognizing α4β7 and α4β1 integrins may be a candidate to explain this particular adherence. One third of the bone marrow biopsies did not exhibit MC nodules or MC infiltration and led to a false negative diagnosis for SM. SM can be discovered in the assessment of fracture or osteoporosis. Transiliac bone biopsy allows for the diagnosis of the disease more accurately than bone marrow biopsy; it also provides a histomorphometric analysis of bone remodeling.
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Affiliation(s)
- B Bouvard
- Groupe études remodelage osseux et biomatériaux (GEROM), EA-4658, SFR-4208, IRIS-Institut de Biologie en Santé (IBS), université d'Angers, CHU d'Angers, 49933 Angers, France; Department of rheumatology, CHU d'Angers, 49933 Angers cedex, France
| | - F Pascaretti-Grizon
- Groupe études remodelage osseux et biomatériaux (GEROM), EA-4658, SFR-4208, IRIS-Institut de Biologie en Santé (IBS), université d'Angers, CHU d'Angers, 49933 Angers, France
| | - E Legrand
- Groupe études remodelage osseux et biomatériaux (GEROM), EA-4658, SFR-4208, IRIS-Institut de Biologie en Santé (IBS), université d'Angers, CHU d'Angers, 49933 Angers, France; Department of rheumatology, CHU d'Angers, 49933 Angers cedex, France
| | - C Lavigne
- Department of internal medicine, CHU d'Angers, 49933 Angers cedex, France
| | - M Audran
- Groupe études remodelage osseux et biomatériaux (GEROM), EA-4658, SFR-4208, IRIS-Institut de Biologie en Santé (IBS), université d'Angers, CHU d'Angers, 49933 Angers, France; Department of rheumatology, CHU d'Angers, 49933 Angers cedex, France
| | - D Chappard
- Groupe études remodelage osseux et biomatériaux (GEROM), EA-4658, SFR-4208, IRIS-Institut de Biologie en Santé (IBS), université d'Angers, CHU d'Angers, 49933 Angers, France.
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Rajakulasingam R, Iqbal A, James SL, Botchu R. Surface adhesive and hand-aided needle-assisted biopsy technique (SAHNA). Skeletal Radiol 2020; 49:469-73. [PMID: 31641806 DOI: 10.1007/s00256-019-03320-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/15/2019] [Accepted: 09/26/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We describe a novel and efficient CT biopsy technique that we have termed 'skin adhesive and hand-aided biopsy technique', shortened to the acronym SAHNA. This technique is ideal for biopsying surface osseous lesions where there is a lack of subcutaneous fat. This avoids the need for the radiologist's hand to be in close proximity to the CT scanner beam at the time of intervention. METHODS The SAHNA technique uses a plastic surgical forceps towel clamp to stabilise the biopsy needle just proximal to the lesion after piercing through the skin. The clamp itself is stabilised via a self-adhesive dressing which is stuck down to the skin at its shank. RESULTS In our institution, we have already used the SAHNA technique successfully in over 5 cases. CONCLUSION The SAHNA technique is a widely accessible and effective way of stabilising the CT biopsy needle in technically challenging superficial bony lesions.
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Asprey W, Knuttinen G, Long JR, Fox M, Flug J, Mayer JP, Schwartz AJ. A novel technique for retrieval of a broken biopsy needle. Skeletal Radiol 2020; 49:307-312. [PMID: 31485680 DOI: 10.1007/s00256-019-03304-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/22/2019] [Accepted: 08/25/2019] [Indexed: 02/02/2023]
Abstract
A broken needle is a rare complication of bone biopsy. We describe an easily applied technique of retrieval of a retained biopsy needle fragment using a cannulated drill typically used for internal fixation of femoral neck fractures. This approach allows for removal under moderate conscious sedation and can be performed by a radiologist using fluoroscopic or CT-fluoroscopic guidance in the radiology suite.
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Affiliation(s)
- Walker Asprey
- Mayo Clinic Alix School of Medicine, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Grace Knuttinen
- Department of Radiology, Mayo Clinic, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Jeremiah R Long
- Department of Radiology, Mayo Clinic, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Michael Fox
- Department of Radiology, Mayo Clinic, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Jonathan Flug
- Department of Radiology, Mayo Clinic, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Jeffrey P Mayer
- Department of Orthopaedic Surgery, Mayo Clinic, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Adam J Schwartz
- Department of Orthopaedic Surgery, Mayo Clinic, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA.
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Huh EH, Yi PH, Ray DM, Hsu LCH, Hui FK, Khan M. Comparison of powered drill & manual bone biopsy systems: Does the diagnostic yield justify the cost? J Clin Neurosci 2020; 73:125-9. [PMID: 31992515 DOI: 10.1016/j.jocn.2020.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/06/2020] [Indexed: 11/23/2022]
Abstract
Bone biopsies are traditionally performed using manual drill devices. More recently, powered drill biopsy systems have been developed, ostensibly to improve diagnostic yield. We compare the powered drill biopsy system to traditional manual needle devices on the basis of diagnostic yield, specimen size and material costs. 309 consecutive bone biopsy procedures performed with imaging guidance from a single academic institution were retrospectively reviewed. Specimen diagnostic adequacy, qualitative interpretation of diagnostically inadequate specimens, aggregate specimen volume and material costs were assessed. Econometric analysis was performed to assess the relationship between materials cost and diagnostic yield. Diagnostic yield and average core specimen volume were significantly higher in the powered drill group, with 86% of cases yielding adequate biopsy specimens versus 67% of cases using the manual method. The materials cost associated with the powered drill device was higher than those of any of the manual needle devices with an average difference of $270.19 per case, however, this was offset due to higher diagnostic yield suggesting that the increased diagnostic accuracy achieved by the powered drill does not carry a significant added financial burden. The powered drill bone biopsy system results in a significantly higher yield of diagnostically adequate biopsy specimens compared to traditional manual needles, possibly attributed to larger and more intact obtained core specimen volumes and is more economically viable off-setting the higher cost.
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Lalayiannis A, Crabtree N, Fewtrell M, Biassoni L, Milford D, Ferro C, Shroff R. Assessing bone mineralisation in children with chronic kidney disease: what clinical and research tools are available? Pediatr Nephrol 2020; 35:937-957. [PMID: 31240395 PMCID: PMC7184042 DOI: 10.1007/s00467-019-04271-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/19/2019] [Accepted: 04/26/2019] [Indexed: 12/11/2022]
Abstract
Mineral and bone disorder in chronic kidney disease (CKD-MBD) is a triad of biochemical imbalances of calcium, phosphate, parathyroid hormone and vitamin D, bone abnormalities and soft tissue calcification. Maintaining optimal bone health in children with CKD is important to prevent long-term complications, such as fractures, to optimise growth and possibly also to prevent extra-osseous calcification, especially vascular calcification. In this review, we discuss normal bone mineralisation, the pathophysiology of dysregulated homeostasis leading to mineralisation defects in CKD and its clinical consequences. Bone mineralisation is best assessed on bone histology and histomorphometry, but given the rarity with which this is performed, we present an overview of the tools available to clinicians to assess bone mineral density, including serum biomarkers and imaging such as dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. We discuss key studies that have used these techniques, their advantages and disadvantages in childhood CKD and their relationship to biomarkers and bone histomorphometry. Finally, we present recommendations from relevant guidelines-Kidney Disease Improving Global Outcomes and the International Society of Clinical Densitometry-on the use of imaging, biomarkers and bone biopsy in assessing bone mineral density. Given low-level evidence from most paediatric studies, bone imaging and histology remain largely research tools, and current clinical management is guided by serum calcium, phosphate, PTH, vitamin D and alkaline phosphatase levels only.
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Affiliation(s)
- A.D. Lalayiannis
- Nephrology Department Great Ormond St. Hospital for Children NHS Foundation Trust and University College London Institute of Child Health, London, UK
| | - N.J. Crabtree
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - M. Fewtrell
- Nephrology Department Great Ormond St. Hospital for Children NHS Foundation Trust and University College London Institute of Child Health, London, UK
| | - L. Biassoni
- Nephrology Department Great Ormond St. Hospital for Children NHS Foundation Trust and University College London Institute of Child Health, London, UK
| | - D.V. Milford
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - C.J. Ferro
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R. Shroff
- Nephrology Department Great Ormond St. Hospital for Children NHS Foundation Trust and University College London Institute of Child Health, London, UK
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Prokop J, Estorninho J, Marote S, Sabino T, Botelho de Sousa A, Silva E, Agapito A. POEMS syndrome: a rare cause of adrenal insufficiency in a young male. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190010. [PMID: 31967972 DOI: 10.1530/edm-19-0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/16/2019] [Indexed: 11/08/2022] Open
Abstract
SUMMARY POEMS syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein and Skin changes) is a rare multisystemic disease. Clinical presentation is variable, the only mandatory criteria being polyneuropathy and monoclonal gammapathy in association with one major and one minor criterion. Primary adrenal insufficiency is rarely reported. We describe a case of a 33-year-old patient, in whom the presenting symptoms were mandibular mass, chronic sensory-motor peripheral polyneuropathy and adrenal insufficiency. The laboratory evaluation revealed thrombocytosis, severe hyperkalemia with normal renal function, normal protein electrophoresis and negative serum immunofixation for monoclonal protein. Endocrinologic laboratory work-up confirmed Addison's disease and revealed subclinical primary hypothyroidism. Thoracic abdominal CT showed hepatosplenomegaly, multiple sclerotic lesions in thoracic vertebra and ribs. The histopathologic examination of the mandibular mass was nondiagnostic. Bone marrow biopsy revealed plasma cell dyscrasia and confirmed POEMS syndrome. Axillary lymphadenopathy biopsy: Castleman's disease. Gluco-mineralocorticoid substitution and levothyroxine therapy were started with clinical improvement. Autologous hematopoietic cell transplantation (HCT) was planned, cyclophosphamide induction was started. Meanwhile the patient suffered two ischemic strokes which resulted in aphasia and hemiparesis. Cerebral angiography revealed vascular lesions compatible with vasculitis and stenosis of two cerebral arteries. The patient deceased 14 months after the diagnosis. The young age at presentation, multiplicity of manifestations and difficulties in investigation along with the absence of serum monoclonal protein made the diagnosis challenging. We report this case to highlight the need to consider POEMS syndrome in differential diagnosis of peripheral neuropathy in association with endocrine abnormalities even in young patients. LEARNING POINTS POEMS syndrome is considered a 'low tumor burden disease' and the monoclonal protein in 15% of cases is not found by immunofixation. Neuropathy is the dominant characteristic of POEMS syndrome and it is peripheral, ascending, symmetric and affecting both sensation and motor function. Endocrinopathies are a frequent feature of POEMS syndrome, but the cause is unknown. The most common endocrinopathies are hypogonadism, primary hypothyroidism and abnormalities in glucose metabolism. There is no standard therapy; however, patients with disseminated bone marrow involvement are treated with chemotherapy with or without HCT.
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Affiliation(s)
- Joanna Prokop
- Departments of Endocrinology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - João Estorninho
- Departments of Endocrinology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Sara Marote
- Departments of Internal Medicine, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Teresa Sabino
- Departments of Endocrinology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Aida Botelho de Sousa
- Departments of Hemato-Oncology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Eduardo Silva
- Departments of Internal Medicine, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Ana Agapito
- Departments of Endocrinology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
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van Steenbergen TRF, Smits M, Scheenen TWJ, van Oort IM, Nagarajah J, Rovers MM, Mehra N, Fütterer JJ. 68Ga-PSMA-PET/CT and Diffusion MRI Targeting for Cone-Beam CT-Guided Bone Biopsies of Castration-Resistant Prostate Cancer Patients. Cardiovasc Intervent Radiol 2019; 43:147-154. [PMID: 31444628 PMCID: PMC6940314 DOI: 10.1007/s00270-019-02312-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/13/2019] [Indexed: 12/19/2022]
Abstract
Introduction Precision medicine expands the treatment options for metastatic castration-resistant prostate cancer (mCRPC) by targeting druggable genetic aberrations. Aberrations can be identified following molecular analysis of metastatic tissue. Bone metastases, commonly present in mCRPC, hinder precision medicine due to a high proportion of biopsies with insufficient tumor cells for next-generation DNA sequencing. We aimed to investigate the feasibility of incorporating advanced target planning and needle guidance in bone biopsies and whether this procedure increases biopsy tumor yield and success rate of molecular analysis as compared to the current standards, utilizing only CT guidance. Materials and Methods In a pilot study, ten mCRPC patients received 68Ga-prostate-specific membrane antigen (PSMA)-PET/CT and diffusion-weighted MRI as biopsy planning images. These datasets were fused for targeting metastatic lesions with high tumor densities. Biopsies were performed under cone-beam CT (CBCT) guidance. Feasibility of target planning and needle guidance was assessed, and success of molecular analysis and tumor yield were reported. Results Fusion target planning and CBCT needle guidance were feasible. Nine out of ten biopsies contained prostate cancer cells, with a median of 39% and 40% tumor cells by two different sequencing techniques. Molecular analysis was successful in eight of ten patients (80%). This exceeds previous reports on CT-guided biopsies that ranged from 33 to 44%. In two patients, important druggable aberrations were found. Discussion A biopsy procedure using advanced target planning and needle guidance is feasible and can increase the success rate of molecular analysis in bone metastases, thereby having the potential of improving treatment outcome for patients with mCRPC. Level of Evidence Level 4, case series.
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Affiliation(s)
- T R F van Steenbergen
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - M Smits
- Department of Medical Oncology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T W J Scheenen
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - I M van Oort
- Department of Urology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Nagarajah
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - M M Rovers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N Mehra
- Department of Medical Oncology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Kamath K, Kamath SU. Percutaneous technique for fluoroscopy-guided biopsy in the supra-acetabular region. Eur J Orthop Surg Traumatol 2019; 29:1801-3. [PMID: 31230122 DOI: 10.1007/s00590-019-02474-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
The peri-acetabular area of the pelvis is a common site for a variety of lesions including neoplasia, histiocytosis or infective-like tuberculosis. A biopsy is necessary before planning treatment for these patients. Access to these lesions requires extensive dissection of soft tissues and is associated with blood loss and prolonged operative time. A percutaneous fluoroscopy-guided technique can be used to perform biopsy of lesions in the roof of the acetabulum through a minimally invasive approach. We have described a simple technique for biopsy of lesions in the acetabular roof using a percutaneous fluoroscopy-guided approach.
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Couturier A, Chabaud A, Desbiez F, Descamps S, Petrosyan E, Letertre-Gilbert P, Mrozek N, Vidal M, Tauveron I, Maqdasy S, Lesens O. Comparison of microbiological results obtained from per-wound bone biopsies versus transcutaneous bone biopsies in diabetic foot osteomyelitis: a prospective cohort study. Eur J Clin Microbiol Infect Dis 2019; 38:1287-1291. [PMID: 30980264 DOI: 10.1007/s10096-019-03547-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
Transcutaneous bone biopsy (TCB) is the gold standard for taking microbiological specimens in diabetic foot osteomyelitis (DFO), but this technique is not widely used in diabetic foot care centers. We aimed to evaluate the reliability of per-wound bone biopsy (PWB) cultures by comparing them with concomitant TCB cultures obtained through healthy skin. This is a prospective monocentric study including patients seen in consultation for clinical and radiological diabetic foot osteomyelitis with positive probe-bone tests between April 2015 and May 2018. Two bone biopsies were performed on each consenting patient: TCB through a cutaneous incision in healthy skin, and PWB, after careful debridement of the wound. A total of 46 paired cultures were available from 43 eligible patients. Overall, 16 (42%) of the PWB and TCB pairs had identical culture results, but the TCB cultures were sterile in 8 (17%) cases. For 38 paired cultures with positive TCB, the correlation between PWB results and TCB results was 58.4%. PWB revealed all microorganisms found in the transcutaneous specimen in 26/38 samples (68.5%). In patients with DFO, the culture results of specimens taken by per-wound biopsies did not correlate well with those obtained by TCB. PWB should be reserved for cases where the transcutaneous biopsy is sterile or not feasible.
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Affiliation(s)
- Alice Couturier
- Department of Infectious and Tropical Diseases, CRIOAc, CHU Clermont-Ferrand, Université Clermont Auvergne UMR CNRS 6023 Laboratoire Microorganismes: Génome Environnement (LMGE), Clermont-Ferrand, France.
| | - Aurore Chabaud
- Department of Physical Medicine and Rehabilitation, CHU Clermont-Ferrand, Université Clermont Auvergne, INRA, 63000, Clermont-Ferrand, France
| | | | - Stéphane Descamps
- Department of Orthopedic Surgery and Traumatology, CRIOAc, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Evelina Petrosyan
- Department of Infectious and Tropical Diseases, CRIOAc, CHU Clermont-Ferrand, Université Clermont Auvergne UMR CNRS 6023 Laboratoire Microorganismes: Génome Environnement (LMGE), Clermont-Ferrand, France
| | - Paule Letertre-Gilbert
- Department of Infectious and Tropical Diseases, CRIOAc, CHU Clermont-Ferrand, Université Clermont Auvergne UMR CNRS 6023 Laboratoire Microorganismes: Génome Environnement (LMGE), Clermont-Ferrand, France
| | - Natacha Mrozek
- Department of Infectious and Tropical Diseases, CRIOAc, CHU Clermont-Ferrand, Université Clermont Auvergne UMR CNRS 6023 Laboratoire Microorganismes: Génome Environnement (LMGE), Clermont-Ferrand, France
| | - Magali Vidal
- Department of Infectious and Tropical Diseases, CRIOAc, CHU Clermont-Ferrand, Université Clermont Auvergne UMR CNRS 6023 Laboratoire Microorganismes: Génome Environnement (LMGE), Clermont-Ferrand, France
| | - Igor Tauveron
- Department of Endocrinology, CHU, Clermont-Ferrand, France
| | - Salwan Maqdasy
- Department of Endocrinology, CHU, Clermont-Ferrand, France
| | - Olivier Lesens
- Department of Infectious and Tropical Diseases, CRIOAc, CHU Clermont-Ferrand, Université Clermont Auvergne UMR CNRS 6023 Laboratoire Microorganismes: Génome Environnement (LMGE), Clermont-Ferrand, France
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Burke MC, Garg A, Youngner JM, Deshmukh SD, Omar IM. Initial experience with dual-energy computed tomography-guided bone biopsies of bone lesions that are occult on monoenergetic CT. Skeletal Radiol 2019; 48:605-613. [PMID: 30343440 DOI: 10.1007/s00256-018-3087-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Our purpose was to determine whether dual-energy CT (DECT), specifically the bone marrow setting of the virtual noncalcium (VNCa) algorithm, could be used to identify and accurately biopsy suspected bone malignancies that were visible on magnetic resonance imaging (MRI), nuclear bone scintigraphy, or positron-emission tomography/computed tomography (PET/CT), but occult on monoenergetic computed tomography (CT) by virtue of being either isodense or nearly isodense to surrounding normal bone. MATERIALS AND METHODS We present 4 cases in which DECT was used to detect various malignant bone lesions and was successfully used to direct percutaneous DECT-guided bone biopsies. RESULTS Two of the lesions were solid tumor metastases (breast and prostate carcinoma), whereas two others were hematological malignancies (leukemia and lymphoma). This technique enabled us to confidently and accurately direct the biopsy needle into the target lesion. CONCLUSION The authors demonstrate that the DECT VNCa bone marrow algorithm may be helpful in identifying isodense bone lesions of various histologies and may be used to guide percutaneous bone biopsies. This technique may help to maximize diagnostic yield, minimize the number of passes into the region of concern, and prevent patients from undergoing repeat biopsy.
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Affiliation(s)
- Michael C Burke
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA.
| | - Ankur Garg
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
| | - Jonathan M Youngner
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
| | - Swati D Deshmukh
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
| | - Imran M Omar
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
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Barshes NR, Mindru C, Trautner BW, Rodriguez-Barradas MC. Discordant isolates in bone specimens from patients with recurrent foot osteomyelitis. Eur J Clin Microbiol Infect Dis 2019; 38:767-9. [PMID: 30719591 DOI: 10.1007/s10096-019-03470-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 01/02/2019] [Indexed: 01/13/2023]
Abstract
We compared paired operative bone cultures (initial operation and reoperation) for 35 patients who experienced foot osteomyelitis treatment failure at a single hospital. Concordance was poor (kappa = 0.180). Staphylococcus aureus, gram negatives, and anaerobes were the most common discordant bacteria seen at reoperation, while Enterococcus was the most persistent.
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Fily F, Ronat JB, Malou N, Kanapathipillai R, Seguin C, Hussein N, Fakhri RM, Langendorf C. Post-traumatic osteomyelitis in Middle East war-wounded civilians: resistance to first-line antibiotics in selected bacteria over the decade 2006-2016. BMC Infect Dis 2019; 19:103. [PMID: 30704410 PMCID: PMC6357381 DOI: 10.1186/s12879-019-3741-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 01/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND War-wounded civilians in Middle East countries are at risk of post-traumatic osteomyelitis (PTO). We aimed to describe and compare the bacterial etiology and proportion of first-line antibiotics resistant bacteria (FLAR) among PTO cases in civilians from Syria, Iraq and Yemen admitted to the reconstructive surgical program of Médecins Sans Frontières (MSF) in Amman, Jordan, and to identify risk factors for developing PTO with FLAR bacteria. METHODS We retrospectively analyzed the laboratory database of the MSF program. Inclusion criteria were: patients from Iraq, Yemen or Syria, admitted to the Amman MSF program between October 2006 and December 2016, with at least one bone biopsy sample culture result. Only bone samples taken during first orthopedic surgery were included in the analysis. To assess factors associated with FLAR infection, logistic regression was used to estimate odds ratio (ORs) and 95% confidence intervals (CI). RESULTS 558 (76.7%) among 727 patients included had ≥1 positive culture results. 318 were from Iraq, 140 from Syria and 100 from Yemen. Median time since injury was 19 months [IQR 8-40]. Among the 732 different bacterial isolates, we identified 228 Enterobacteriaceae (31.5%), 193 Staphylococcus aureus (26.3%), 99 Pseudomonas aeruginosa (13.5%), and 21 Acinetobacter baumanii (2.8%). Three hundred and sixty four isolates were FLAR: 86.2% of Enterobacteriaceae, 53.4% of Pseudomonas aeruginosa, 60.5% of S. aureus and 45% of Acinetobacter baumannii. There was no difference in bacterial etiology or proportion of FLAR according to the country of origin. In multivariate analysis, a FLAR infection was associated with an infection of the lower extremity, with a time since the injury ≤12 months compared with time > 30 months and with more than 3 previous surgeries. CONCLUSIONS Enterobacteriaceae were frequently involved in PTO in war wounded civilians from Iraq, Yemen and Syria between 2006 and 2016. Proportion of FLAR was high, particularly among Enterobacteriaceae, regardless of country of origin.
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Affiliation(s)
- Fabien Fily
- Epicentre, 55 rue Crozatier, 75012, Paris, France. .,Infectious Diseases Unit, Broussais Hospital, Saint Malo, France.
| | | | - Nada Malou
- Médecins Sans Frontières, 8 rue St Sabin, 75011, Paris, France
| | | | - Caroline Seguin
- Médecins Sans Frontières, 8 rue St Sabin, 75011, Paris, France
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Sharma AK, Toussaint ND, Elder GJ, Masterson R, Holt SG, Robertson PL, Ebeling PR, Baldock P, Miller RC, Rajapakse CS. Magnetic resonance imaging based assessment of bone microstructure as a non-invasive alternative to histomorphometry in patients with chronic kidney disease. Bone 2018; 114:14-21. [PMID: 29860153 DOI: 10.1016/j.bone.2018.05.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) adversely affects bone microarchitecture and increases fracture risk. Historically, bone biopsy has been the 'gold standard' for evaluating renal bone disease but is invasive and infrequently performed. High-resolution magnetic resonance imaging (MRI) quantifies bone microarchitecture noninvasively. In patients with CKD, it has not been compared with results derived from bone biopsy or with imaging using dual energy X-ray absorptiometry (DXA). METHODS Fourteen patients with end-stage kidney disease (ESKD) underwent MRI at the distal tibia, bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA; hip and spine) and transiliac bone biopsies with histomorphometry and microcomputed tomography (micro-CT). All patients had biomarkers of mineral metabolism. Associations were determined by Spearman's or Pearson's rank correlation coefficients. RESULTS MRI indices of trabecular network integrity, surface to curve ratio (S/C) and erosion index (EI), correlated to histomorphometric trabecular bone volume (S/C r = 0.85, p = 0.0003; EI r = -0.82, p = 0.001), separation (S/C r = -0.58, p = 0.039; EI r = 0.79, p = 0.0012) and thickness (S/C, r = 0.65, p = 0.017). MRI EI and trabecular thickness (TbTh) also correlated to micro-CT trabecular separation (EI r = 0.63, p = 0.02; TbTh r = -0.60, p = 0.02). Significant correlations were observed between histomorphometric mineralization and turnover indices and various MRI parameters. MRI-derived trabecular parameters were also significantly related to femoral neck BMD. CONCLUSIONS This study highlights the heterogeneity of bone microarchitecture at differing skeletal sites. MRI demonstrates significant, relevant associations to important bone biopsy and DXA indices and warrants further investigation to assess its potential to non-invasively evaluate changes in bone structure and quality over time.
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Affiliation(s)
- Ashish K Sharma
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia; Department of Medicine (RMH), University of Melbourne, Parkville, Australia.
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia; Department of Medicine (RMH), University of Melbourne, Parkville, Australia
| | - Grahame J Elder
- Department of Renal Medicine, Westmead Hospital, Westmead, Australia; Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Rosemary Masterson
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia; Department of Medicine (RMH), University of Melbourne, Parkville, Australia
| | - Stephen G Holt
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia; Department of Medicine (RMH), University of Melbourne, Parkville, Australia
| | - Patricia L Robertson
- Department of Medicine (RMH), University of Melbourne, Parkville, Australia; Department of Radiology, The Royal Melbourne Hospital, Parkville, Australia
| | | | - Paul Baldock
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Rhiannon C Miller
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
| | - Chamith S Rajapakse
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
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Custodio MR, Elias RM, Velasquez WD, Dos Reis LM, Oliveira IB, Moysés RMA, Carvalho AB, Jorgetti V. The unexpected presence of iron in bone biopsies of hemodialysis patients. Int Urol Nephrol 2018; 50:1907-12. [PMID: 30136087 DOI: 10.1007/s11255-018-1936-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/06/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Bone biopsy defines classical diseases that constitute the renal osteodystrophy. There is a recent concern regarding other histological findings that are not appreciated by using the turnover, mineralization, and volume (TMV) classification. Iron (Fe) overload has been considered a new challenge and the real significance of the presence of this metal in bones is not completely elucidated. Therefore, the main goal of the current study was to not only to identify bone Fe, but also correlate its presence with demographic, and biochemical characteristics. METHODS This is a cross-sectional analysis of bone biopsies performed in 604 patients on dialysis from 2010 to 2014 in a tertiary academic Hospital. RESULTS Histomorphometric findings revealed the presence of Fe in 29.1%. Fe was associated with higher levels of serum ferritin and serum calcium. No TMV status was related to Fe bone overload. CONCLUSION Our study has highlighted that the presence of Fe in one-third of bone samples has unknown clinical significance. The lack of other contemporary bone biopsy study reporting Fe prevents us from comparison. The findings presented here should be specifically addressed in a future research and will require attention prior to implementation of any clinical guideline. If any proposed treatment, however, would change the bone Fe-related morbidity is undetermined.
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Hansford BG, Smith ZC, Stacy GS. Imaging of Benign Fibular Tumours and Their Mimics. Can Assoc Radiol J 2018; 69:293-302. [PMID: 30078399 DOI: 10.1016/j.carj.2018.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Barry Glenn Hansford
- Department of Diagnostic Radiology, Oregon Health and Sciences University, Portland, Oregon, USA.
| | - Zachary C Smith
- Department of Radiology, University Medical Center, University of Utah, Salt Lake City, Utah, USA
| | - Gregory Scott Stacy
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois, USA
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