CT引导经皮穿刺活检术对脊柱病变的临床诊断价值

 目的   评估CT引导经皮穿刺活检对脊柱病变的临床诊断价值。方法    回顾性分析行CT引导经皮穿刺活检并经手术病理和(或)临床随访证实的127例脊柱病变的病例资料,活检部位包括颈椎5例、胸椎50例,腰椎58例、骶椎14例,所有活检标本送病理科进行组织病理学检查。所有病例通过后续手术病理和(或)临床随访确定最终诊断,以此为标准评价穿刺活检病理诊断的准确率;计算不同影像学诊断的准确率、敏感性及特异性,并与穿刺活检病理诊断相比较。结果    127例穿刺活检术活检成功率为99.21% (126/127),所有患者均未发生严重并发症。穿刺活检获得明确诊断119例(恶性病变56例,良性病变63例),7例无法明确诊断或出现阴性结果。经随访和(或)手术病理证实,最终确诊127例中良性病变67例,恶性病变60例。穿刺活检总的诊断准确率为92.06%(116/126),恶性和良性病变诊断准确率分别为93.33% (56/60)和90.91% (60/66),差异无统计学意义(χ2=0.03,P=0.863);穿刺活检术前单纯CT、MRI和核医学影像检查对脊柱病变的诊断准确率分别为69.54%、68.48%和75.64%,均明显低于CT引导下穿刺活检诊断准确率。结论    CT引导下经皮脊柱穿刺活检具有安全、有效、微创、准确率高等特点,可弥补单纯影像学诊断准确率偏低的局限性,是确诊脊柱病变的良好活检方式。

The value of CT-guided percutaneous biopsy in the clinical diagnosis of spinal lesions

Objective   To evaluate the value of CT-guided percutaneous biopsy in the clinical diagnosis of spinal lesions.Methods    One hundred and twenty-seven cases of spinal lesions confirmed by surgical pathology and (or) clinical follow-up were retrospectively analyzed.All patients underwent CT-guided percutaneous biopsy.The biopsy sites included 5 cervical segments,50 thoracic segments,58 lumbar segments and 14 sacral segments.All biopsy specimens were sent to the Department of Pathology for histopathological examination.All cases were determined the final diagnosis by follow up operation pathology and (or) clinical follow-up.Therefore,the accuracy of pathological diagnosis was evaluated,and the accuracy,sensitivity and specificity of different imaging diagnosis were calculated and compared with the pathological diagnosis of biopsy.Results   The success rate of biopsy in 127 cases was 99.21% (126/127).None of the patients had serious complications.One hundred and nineteen cases (56 malignant lesions,63 benign lesions) got clear diagnosis by biopsy,and 7 cases could not be diagnosed clearly or had negative results.After clinical follow-up and (or) pathologic results confirmed,there were 67 benign lesions and 60 malignant lesions in 127 cases,and the total diagnostic accuracy was 92.06% (116/126).The diagnostic accuracy of malignant and benign lesions were 93.33% (56/60) and 90.91% (60/66) respectively,and there was no statistical significance (χ2=0.03,P=0.863).The diagnostic accuracy of CT,MRI and nuclear medical imaging for spinal lesions were 69.54%,68.48% and 75.64%,respectively,which were significantly lower than that of biopsy.Conclusions    Percutaneous spinal biopsy under the CT-guided has the advantages of safe,effective,minimally invasive and high accuracy,which can make up for the limitation of the low accuracy rate of simple imaging diagnosis,and it is a good way to clear the diagnosis of spinal lesions.