CT/USG -Guided Biopsy Ensures High Diagnostic Yield in Spinal Tuberculosis: Indian Researchers Report

Led by Anil K. Jain from the Department of Pathology, Gandhi Medical College, the study evaluated whether tissue obtained through minimally invasive percutaneous techniques could reliably confirm spinal TB using a combination of laboratory methods.

Spinal TB, caused by Mycobacterium tuberculosis, often presents subtly and is difficult to diagnose in its early stages. Delayed confirmation can lead to serious complications such as spinal deformity and neurological deficits. Speaking to Medical Dialogues, Dr. Jain explained that establishing a diagnosis is particularly challenging because spinal lesions are deep-seated, making tissue procurement difficult. He noted that this challenge prompted the evaluation of image-guided biopsy techniques to determine whether adequate tissue could be obtained for accurate diagnosis.

The study included 68 patients with clinically and radiologically suspected spinal TB who underwent CT or ultrasound-guided aspiration. The collected samples were subjected to multiple diagnostic modalities, including histopathology, cytology, acid-fast bacilli (AFB) smear, culture, and molecular tests such as CBNAAT and line probe assay (LPA).   

Key Findings:

Dr. Jain emphasized that relying on a single test may lead to missed diagnoses. Instead, he recommended that clinicians simultaneously utilize all available diagnostic methods on tissue obtained through guided biopsy to ensure accurate and early detection. This approach, he noted, allows timely initiation of anti-tubercular therapy (ATT), which is critical in preventing disease progression and improving patient outcomes.

He further highlighted the importance of maintaining a high index of suspicion in endemic regions like India. Persistent, localized spinal pain should prompt further evaluation, including MRI, to identify possible lesions. If imaging suggests spinal TB, percutaneous biopsy should be performed to confirm the diagnosis before initiating treatment as far as possible.

The study also highlighted the role of repeat biopsy in cases where patients do not respond adequately to ATT. In such scenarios, guided tissue sampling can help detect drug resistance and guide appropriate modifications in therapy.

Importantly, Dr. Jain pointed out that this diagnostic strategy is feasible even in resource-limited settings. With imaging-guided aspiration facilities increasingly available at district-level healthcare centers and support from national TB programs, implementing a combined diagnostic approach is both practical and necessary in high-burden countries.

Overall, the findings reinforce that CT/USG-guided biopsy provides adequate tissue for comprehensive testing and should be integrated into routine clinical practice for suspected spinal TB cases to ensure accurate and timely diagnosis.