Biopsy in Orthopedics and Risk of Bacterial Contamination During Tissue Sampling: Facts and Strategies View PDF

Francisco Rodriguez-Fontan
Department Of Orthopedics, University Of Colorado, Anschutz Medical Campus, Aurora, Colorado, United States

Published on: 2024-10-01

Abstract

Biopsies in the field of orthopedics are used to guide diagnostics and treatment options for the disease process that may be occurring such as a tumor or infection. Skin preparation of these biopsies follows the standard skin preparation for a surgical procedure, with the aim to decrease the amount of microbiota that could lead to contamination of the tissue biopsy and even possible infection. The tissue obtained from the biopsy often undergoes pathology and culture. The reported bacterial contamination rate is roughly below 4%. This review questions how samples from the biopsies are getting contaminated by microbiota that remains on the skin and how it affects infection management. In addition, which techniques or steps can decrease the rate of contamination when performing a biopsy. Our review identified little to no data on investigating bacterial contamination of biopsies. In doing this, the review identified different factors implicated in skin microbiota awareness: skin preparation techniques and solutions, variation of typical microbiota that colonize the skin based on the anatomical region, preoperative withholding versus administrating antibiotics prophylactically and using different scalpel blades for superficial and deep incisions, among others. Although we failed to identify any data that provided answers to our original question and quantify each factor individually, most studies in different orthopedic fields provided significant findings to some extent. We outline some practical recommendations based on consensus and theoretical effectiveness in decreasing the contamination rate. Further research entailing skin microbiota contamination of a biopsy is needed in the field of orthopedics.

Keywords

Biopsy contamination, Infection, Microbiota, Prepping, Sampling

Introduction

A biopsy is sampling of tissue to identify the presence, cause, and degree of a disease. The goal is to obtain an accurate diagnosis in the context of a growing or aggressive appearing lesion and/or to rule out an infection [1]. Biopsies are sent standardly to the lab as fresh or frozen samples for evaluation of pathology, cytology, and culturing (i.e., aerobic, anaerobic, acid fast bacterial, and fungal) [1, 2].

There are several ways to perform a biopsy and choosing the approach is based on the reasoning, surgeon preference, anatomic location, and, in the case of a malignant lesion, on anticipation of possible mass excision and including this in the planned future surgical field [1]. Fine needle aspiration (FNA) is used to obtain cells within the lesion, primarily used for diagnoses of carcinomas; core biopsy is used to evaluate both the structural and the cellular aspects of a lesion, and is primarily used to diagnose sarcomas; incisional biopsies, historically the gold standard, allows for access to deeper lesions without seeding the surrounding structures through an incision of the skin; and an excisional biopsy is the removal of an entire lesion or mass, primarily for small and superficial [1]. Incisional biopsies have been shown to be more accurate in diagnoses with 94 - 95% success rate as compared to FNA (83% - 100% success rate) [1, 2].