Puncture Biopsy and Combined Testing to Improve the Accuracy of Pathogenic Diagnosis in Spinal Infection
Objective To explore the value of puncture biopsy and combined detection in the pathogenic diagnosis for spinal infection.Methods A total of 287 suspected spinal infection patients admitted from August 2022 to August 2023 in the Department of Spinal Infection Surgery,Shandong Provincial Public Health Clinical Center were selected for C-arm guided puncture biopsy,and tissue samples were sent for combined testing(culture,smear,genetic and pathological examinations).Using clinical results as the gold standard,the sensitivity,specificity,positive predictive value,and negative predictive value of single culture and combined test were calculated and compared,ROC curves were drawn,and the area under the curve(AUC)was calculated.Results A total of 287 biopsies were performed successfully,with 238 intervertebral disc specimens and 49 vertebral bone specimens.Clinical pathogenic results showed there were 54 cases of Mycobacteriumtuberculosis,59 cases of Brucella,153 cases of general bacterial infection,5 cases of nontuberculosis mycobacterium,and 3 cases of fungal infection.The sensitivity of combined detection and culture alone was 92.17％and 58.15％,the specificity was 95.56％and 91.65％,positive predictive value was 98.77％and 96.32％,and negative predictive value was 51.82％and 91.25％,respectively.The sensitivity and negative predictive value of combined detection were higher than those of culture alone(P＜0.05).The AUC of combined test was 0.87,which was significantly higher than that of single cultured(0.58)(P＜0.05).Conclusion C-arm guided puncture biopsy is an important means for clarifying the etiology of spinal infection.Simple culture has a certain rate of missed diagnosis and misdiagnosis,and combined detection can improve diagnostic efficiency.
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