The current gold standard for diagnosing osteomyelitis is a bone biopsy.  However, recent literature has challenged this notion due to variability within pathologist assessments and methods of obtaining a sample. In this article, the bone biopsy is compared to culture and genetic sequencing to determine if the gold standard is still reliable. The results from the study determined a variability in incidence between the different modalities with bone cultures identifying more cases of osteomyelitis than histology, 68.6% vs 45.7%. Genetic sequencing identified an even greater number of cases at 82.9% vs 45.7% when compared to histology.

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Lavery LA, Crisologo PA, La Fontaine J, et al. Are We Misdiagnosing Diabetic Foot Osteomyelitis? Is the Gold Standard Gold? J Foot Ankle Surg. 2019 Jul;58(4):713-716.

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