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title:The Role of Image Guided Biopsy in Suspected Tuberculosis of Spine

Author:S A Mustafa Johar, Prasad Patgaonkar, Vivek Patel, Murtuza Rassiwala, Anshul Patel, Setul Shah

Keywords:Tuberculosis, Spine, Image guided biopsy, BACTEC, CBNAAT

Type:Original Article

Abstract:Introduction: India accounts for 25% of the total global TB burden, and a third of the “missing cases” that do not get diagnosed or notified. When health professional in India think of TB, they often order non-specific tests while TB can only be confirmed by microbiological tests such as sputum smear microscopy, Gene Xpert, and cultures. This study was conducted to study the role of image guided biopsy in all suspected Tuberculosis Spine cases, in terms of establishing diagnosis and to study the sensitivity and specificity of diagnostic procedures (biopsy as well as culture methods). Also, the researchers compared the available investigations results of CBNAAT, BACTEC, HPE & AFB Stain. Methodology: The present study was conducted at the Department of Orthopaedics of our institute. It was a prospective study carried out from January 2015 to June 2016. 53 patients presented to us were suspected spinal tuberculosis on Clinico- radiological ground and were posted for bone biopsy. Results: In our study, mean age of the patients is 42.5±14.3 (Range 14–73 years). Out of 53, 34 patients (64.15 %) were male and 19 (35.85 %) were female. Patients have usually presented in early destructive stage of the disease (Type 2) (30/53). We have used USG guided aspiration (04/53), CT guided biopsy (22.64%) and in majority of cases IITV guided biopsy (37/53). 4 of 53 cases were excluded, as they were inconclusive due to inadequate sample obtained during biopsy. Diagnosis was established in 38 out of 53 patients (70.71 %). Sensitivity and specificity of Z-N stain were 42.1%, and 90.9%, of HPE were 81.5% and 90.9%; of BACTEC were 89.4% and 100% respectively. Conclusion: In the present study, it is observed that no single diagnostic modality is having a good negative predictive value. Hence, a combination of diagnostic battery is required for precise diagnosis and better results. The result of BACTEC culture and CBNAAT has detected a maximum of 38 cases. While the result of Z-N microscopy and histopathology has detected small number of cases. As culture takes long incubation time for results, the CBNAAT can be applied for rapid detection of Pott's disease.

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