Additional information on the role of histopathology in diagnosing diabetic foot osteomyelitis

Abstract

Bone biopsy with both microbiological and histopathological purposes has been established as a high-quality criterion for diagnosing osteomyelitis in the feet of patients with diabetes [1]. However, some controversies have been reported, making the interpretation of the results difficult. A group of authors reported that 29.1% of patients with positive cultures of bone specimens had no histopathological findings of osteomyelitis in one series of patients with diabetes undergoing surgery for foot infections. They also reported that 25% of patients with positive histology had negative cultures [2]. Other authors had also reported such controversies [3], even when advanced imaging was performed as a diagnostic tool [4]. Furthermore, the agreement between pathologists diagnosing osteomyelitis in the feet of patients with diabetes could be below the level of 'reference standard' [5]. Finally, little information exists about histopathology in cases of Charcot neuroarthropathy, and it is well known that the clinical and radiological differentiation between Charcot neuroarthropathy and osteomyelitis is sometimes difficult.