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Statistical Reliability of Bone Biopsy for the Diagnosis of Diabetic Foot Osteomyelitis

      We would like to comment on an article by Meyr et al (
      • Meyr A.J.
      • Singh S.
      • Zhang X.
      • Khilko N.
      • Mukherjee A.
      • Sheridan M.J.
      • Khurana J.S.
      Statistical reliability of bone biopsy for the diagnosis of diabetic foot osteomyelitis.
      ) and describe our experience with diabetic foot osteomyelitis (
      • Cecilia-Matilla A.
      • Lázaro-Martínez J.L.
      • Aragón-Sánchez J.
      • García-Morales E.
      • García-Álvarez Y.
      • Beneit Montesinos J.V.
      Histopathology of bone infection complicating foot ulcers in diabetic foot.
      ). We recently published a histopathologic classification of osteomyelitis according to the cell groups present and the histopathologic changes in the bone samples analyzed (
      • Cecilia-Matilla A.
      • Lázaro-Martínez J.L.
      • Aragón-Sánchez J.
      • García-Morales E.
      • García-Álvarez Y.
      • Beneit Montesinos J.V.
      Histopathology of bone infection complicating foot ulcers in diabetic foot.
      ). We have shown that with the use of a perfectly defined theoretical framework, the interpretation of the data observed in the bone biopsy is no longer subjective and the interobserver variability decreases.
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      References

        • Meyr A.J.
        • Singh S.
        • Zhang X.
        • Khilko N.
        • Mukherjee A.
        • Sheridan M.J.
        • Khurana J.S.
        Statistical reliability of bone biopsy for the diagnosis of diabetic foot osteomyelitis.
        J Foot Ankle Surg. 2011; 50: 663-667
        • Cecilia-Matilla A.
        • Lázaro-Martínez J.L.
        • Aragón-Sánchez J.
        • García-Morales E.
        • García-Álvarez Y.
        • Beneit Montesinos J.V.
        Histopathology of bone infection complicating foot ulcers in diabetic foot.
        J Am Podiatr Med Assoc. 2013; 103: 24-31
        • Waldvogel F.A.
        • Medoff G.
        • Swartz M.N.
        Osteomyelitis: a review of clinical features, therapeutic considerations and unusual aspects.
        N Engl J Med. 1970; 282: 198-206
        • Hartemann-Heurtier A.
        • Senneville E.
        Diabetic foot osteomyelitis.
        Diabetes Metab. 2008; 34: 87-95

      Linked Article

      • Statistical Reliability of Bone Biopsy for the Diagnosis of Diabetic Foot Osteomyelitis
        The Journal of Foot and Ankle SurgeryVol. 50Issue 6
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          Bone biopsy is often referred to as the reference standard for the diagnosis of diabetic foot osteomyelitis (OM), and it also serves as an important interventional tool with respect to diabetic foot infections and limb salvage. However, the phrase bone biopsy lacks a standardized definition, and the statistical reliability of the pathologic diagnosis has not been previously examined. The objective of the present study was to quantify the reliability of the histopathologic analysis of bone with respect to the diagnosis of diabetic foot OM.
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      • Reply
        The Journal of Foot and Ankle SurgeryVol. 52Issue 5
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          I welcome the publication of the investigation alluded to by the authors of the preceding letter. We clearly have a lot to learn with respect to the diagnosis of diabetic foot osteomyelitis (OM), and their proposed histopathologic classification system could prove to be an important step forward. I will especially consider whether their investigation examined the ability of pathologists to determine the difference between osteomyelitic and nonosteomyelitic bone, or whether it examined only the difference among different forms of OM after the primary diagnosis had been established.
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