同轴活检穿刺针在CT导向腹部病变穿刺活检中的应用

目的:探讨同轴穿刺针在腹部病变活检中的应用价值。方法:应用17G或19G同轴穿刺针对40例腹部疾病患者41个病灶在CT导向下进行穿刺活检,病灶位于肝脏(n=13)、腹膜后(n=24)、腹腔(n=2)、盆腔(n=2),病灶大小为1.0 cm×1.0 cm~10.1 cm×12.3 cm。结果:40例41个病灶均成功进行了穿刺活检及细胞学检查,40个进行了病理检查。经手术证实和临床随访观察,活检病理诊断符合率为90.0%(36/40),其中恶性病变的诊断符合率为92%(23/25),良性病变的诊断符合率为86.7%(13/15)。所有病例均无严重并发症发生。结论:CT导引下同轴穿刺针穿刺活检是腹部病变的一种简单、安全、准确的诊断方法。     

Intravascular Ultrasound-Guided Transvenous Biopsy of Abdominal and Pelvic Targets Difficult to Access by Percutaneous Needle Biopsy: Technique and Initial Clinical Experience

PurposeTo report initial clinical experience with intravascular ultrasound (US)-guided transvenous biopsy (TVB) for perivascular target lesions in the abdomen and pelvis using side-viewing phased-array intracardiac echocardiography catheters.Materials and MethodsIn this single-institution, retrospective study, 48 patients underwent 50 intravascular US-guided TVB procedures for targets close to the inferior vena cava or iliac veins deemed difficult to access by conventional percutaneous needle biopsy (PNB). In all procedures, side-viewing phased-array intracardiac echocardiography intravascular US catheters and transjugular liver biopsy sets were inserted through separate jugular or femoral vein access sheaths, and 18-gauge core needle biopsy specimens were obtained under real-time intravascular US guidance. Diagnostic yield, diagnostic accuracy, and complications were analyzed.ResultsIntravascular US-guided TVB was diagnostic of malignancy in 40 of 50 procedures for a diagnostic yield of 80%. There were 5 procedures in which biopsy was correctly negative for malignancy, with a per-procedure diagnostic accuracy of 90% (45/50). Among the 5 false negatives, 2 patients underwent repeat intravascular US-guided TVB, which was diagnostic of malignancy for a per-patient diagnostic accuracy of 94% (45/48). There were 1 (2%) mild, 2 (4%) moderate, and 1 (2%) severe adverse events, with 1 moderate severity adverse event (venous thrombosis) directly attributable to the intravascular US-guided TVB technique.ConclusionsIntravascular US-guided TVB performed on difficult-to-approach perivascular targets in the abdomen and pelvis resulted in a high diagnostic accuracy, similar to accepted thresholds for PNB. Complication rates may be slightly higher but should be weighed relative to the risks of difficult PNB, surgical biopsy, or clinical management without biopsy.     

Retrieval Rate and Accuracy of Ultrasound-Guided 14-G Semi-Automated Core Needle Biopsy of Breast Microcalcifications

Objective

To evaluate the retrieval rate and accuracy of ultrasound (US)-guided 14-G semi-automated core needle biopsy (CNB) for microcalcifications in the breast.

Materials and Methods

US-guided 14-G semi-automated CNB procedures and specimen radiography were performed for 33 cases of suspicious microcalcifications apparent on sonography. The accuracy of 14-G semi-automated CNB and radiology-pathology concordance were analyzed and the microcalcification characteristics between groups with successful and failed retrieval were compared.

Results

Thirty lesions were successfully retrieved and the microcalcification retrieval rate was 90.9% (30/33). Thirty lesions were successfully retrieved. Twenty five were finally diagnosed as malignant (10 invasive ductal carcinoma, 15 ductal carcinoma in situ [DCIS]) and five as benign. After surgery and mammographic follow-up, the 25 malignant lesions comprised 12 invasive ductal carcinoma and 13 DCIS. Three lesions in the failed retrieval group (one DCIS and two benign) were finally diagnosed as two DCIS and one benign after surgery. The accuracy of 14-G semi-automated CNB was 90.9% (30/33) because of two DCIS underestimates and one false-negative diagnosis. The discordance rate was significantly higher in the failed retrieval group than in the successful retrieval group (66.7% vs. 6.7%; p < 0.05). Punctate calcifications were significantly more common in the failed retrieval group than in the successful retrieval group (66.7% vs. 3.7%; p < 0.05).

Conclusion

US-guided 14-G semi-automated CNB could be a useful procedure for suspicious microcalcifications in the breast those are apparent on sonography.     

Percutaneous CT-Guided Core Needle Biopsy Versus Fine Needle Aspiration in Diagnosing Pneumonia and Mimics of Pneumonia

The purpose of this study was to determine the diagnostic value of percutaneous core needle biopsy (CNB) relative to fine needle aspiration (FNA) in patients with pneumonia and pneumonia mimics. In this prospective study we present our experience with 48 thoracic FNAs and CNBs carried out on 48 patients with pneumonia and pneumonia mimics. Samples were obtained from all patients using both CNB (with an automated 18-G core biopsy needle and a gun) and FNA (with a 22-G needle). A specific diagnosis was made in 10/48 cases (20.83%) by FNA and in 42/48 (87.5%) by CNB. The main complications encountered were pneumothorax (n = 4) and hemoptysis (n = 2), yielding a total complication rate of 12.5%. We concluded that CNB using an automated biopsy gun results in a higher diagnostic accuracy for pneumonia and pneumonia mimic biopsies than FNA. Complications should be considered and proper patient observation should follow the procedure.     

CT导向下切割活检在纵隔病变诊断中的应用价值

目的 探讨经皮针刺切割活检纵隔病变的临床应用价值.方法 回顾性分析52例纵隔肿瘤CT导向下经皮针刺切割活检术.穿刺针为美国MD公司TRU-CORE 18 G切割针,52例均做切割病理组织学检查,6例加做免疫组化.结果 (1)病变部位前纵隔49例,中纵隔1例,后纵隔2例;(2)43例病理诊断明确,9例病理诊断不确定.穿刺活检正确率为82.7% ,假阴性率为17.3% ,假阳性病例1例;(3)淋巴瘤活检准确性为50%, 辅以免疫组织化学后切割活检的准确性为80%,明显提高了穿刺活检的诊断准确率(χ2 = 3. 96 ,P<0.05);(4) 8 例小病灶穿刺敏感性为50%,44 例大病灶穿刺敏感性为84.1%,穿刺阳性率与病灶大小无关(确切概率法P>0. 05);(5)胸腺类肿瘤、淋巴结转移性癌活检准确性分别为93%、100% ,淋巴瘤活检准确性仅为50%, 胸腺类肿瘤、淋巴结转移性癌活检阳性率显著高于淋巴瘤(P < 0.05)与前2组比较有统计学意义(P < 0.05);(6) 穿刺并发症发生率为9.6%.气胸发生率为5.8%.结论 CT导向下经皮切割活检术是纵隔病变安全而有价值的诊断方法,辅以免疫组织化学技术可以很大提高纵隔病变的诊断正确率.     

CT引导经皮肺切割活检术诊断活动性韦格纳肉芽肿

目的　探讨CT引导下经皮肺芯针切割活检术 (percutaneousCT-guidedcoreneedlebiopsy, PTCB)对活动性韦格纳肉芽肿(WG)的诊断价值以及指导临床治疗的意义。方法　 8例经PTCB行病理组织学检查WG病人,根据其临床资料作BVAS评分,其结果与病理对照研究。结果　 8例病人经PTCB取得足够的组织学标本,病理结果:①坏死性血管炎 ( 75% ),②肉芽性炎症(62. 5% ),③实质坏死 (50% ),④肺出血改变 (12. 5% ),⑤纤维化 (12. 5% )。确诊时BVAS平均分数为 10分,所有病人确诊后都进行了糖皮质激素联合细胞毒药物冲击治疗,临床有不同程度好转,治疗 4周后平均分数为 2. 5分。结论　多部位、多次经皮肺切割活检可以准确的诊断活动性WG,指导临床早期治疗。     

CT导向下经皮针刺活检前纵隔肿瘤

目的　探讨经皮针刺活检前纵隔肿瘤的影响穿刺准确性的因素。资料与方法　回顾性分析 80例前纵隔肿瘤CT导向下经皮针刺活检术。结果　 (1)病理学明确诊断 6 7例 ,不能确定诊断 13例 ;(2 )细针抽吸、切割针活检穿刺敏感性分别为 75 %、90 .5 % ;(3) 16例小病灶穿刺敏感性为 6 8.8% ,6 4例大病灶穿刺敏感性为 87.5 % ;(4)胸腺类肿瘤、淋巴结转移性癌活检准确性均为 92 % ,淋巴瘤活检准确性仅为 6 5 % ,与前两组比较有统计学意义(P <0 .0 5 ) ;(5 )穿刺并发症发生率为 7.5 %。结论　切割针活检阳性率高于细针活检 ,活检阳性率大病灶高于小病灶 ,胸腺类肿瘤、淋巴结转移性癌活检阳性率显著高于淋巴瘤 ;CT导向下经皮针刺活检术是前纵隔肿瘤安全、有价值的诊断方法。     

CT导向经皮肺活检的临床应用

31例肺部肿块病人在CT导向下作了经皮针吸肺活检术,其中肺癌16例,肺穿刺活检准确率87.5%;良性病变15例,肺穿刺活检准确率93%、术后气胸3例(9.7%),小量出血1例(3.2%).CT扫描图像清晰.病灶定位准确.因此CT导向经皮肺活检术安全、准确、成功率高,在肺部肿块的诊断中有重要作用.     

Percutaneous Image-Guided Core Needle Biopsy of Neuroendocrine Tumors: How Common Is Intraprocedural Carcinoid Crisis?

PurposeTo retrospectively evaluate the incidence of carcinoid crisis, other complications, and physiologic disturbances during percutaneous image-guided core needle biopsy of neuroendocrine tumors (NETs) in the lung and the liver.Materials and MethodsBetween January 2010 and January 2020, 106 computed tomography (CT) or ultrasound (US)-guided core needle biopsies of lung and liver NETs were performed in 95 consecutive adult patients. The mean age was 64 ± 13 years, and 48% were female. The small bowel was the most common primary site (33%, 31/95), and 32 (34%) patients had pre-existing symptoms of carcinoid syndrome. The mean tumor size was 3.2 ± 2.6 cm, and mean number of passes was 3.4 ± 1.6. A 17/18-gauge needle was used in 91% (96/106) of the biopsies. Thirteen (12%) patients received either outpatient or prophylactic octreotide.ResultsNo patients experienced carcinoid crisis or needed octreotide, inotropes, vasopressors, or resuscitation. A single biopsy procedure (0.9%, 1/106) was complicated by bleeding that required angiographic hepatic artery embolization. Changes in pre-biopsy- versus post-biopsy systolic blood pressure and heart rate were -1.6 mm Hg (P = .390) and 0.6 beat/min (P = .431), respectively. Tumor functional status, overall tumor burden, and the elevation of neuroendocrine markers were not associated with intraprocedural physiologic disturbances. There were 4 minor complications (0.4%, 4/106) associated with the biopsy procedure that were not attributed to hormone excretion from tumor manipulation.ConclusionsPercutaneous image-guided core biopsy of NETs is safe, with low complication rate and no definite carcinoid crisis in the current cohort.     

Direction of the Biopsy Needle in Ultrasound-Guided Renal Biopsy Impacts Specimen Adequacy and Risk of Bleeding

IntroductionAlthough medical factors such as hypertension and coagulopathy have been identified that are associated with hemorrhage after renal biopsy, little is known about the role of technical factors. The purpose of our study was to examine the effects of biopsy needle direction on renal biopsy specimen adequacy and bleeding complications.MethodsTwo hundred and forty-two patients who had undergone ultrasound-guided renal biopsies were included. A printout of the ultrasound picture taken at the time of the biopsy was used to measure the biopsy angle (“angle of attack” [AOA]) and to determine if the biopsy needle was aimed at the upper or lower pole and if the medulla was targeted or avoided.ResultsOf the 3 groups of biopsy angle, an AOA of between 50°-70° yielded the most glomeruli per core (P = .001) and the fewest inadequate specimens (4% vs 15% for > 70°, and 9% for < 50°, P = .038). Biopsy directed at a pole vs an interpolar region resulted in fewer inadequate specimens (8% vs 23%, P = .005), while biopsies that were medulla-avoiding resulted in fewer inadequate specimens (5% vs 16%, P = .004) and markedly reduced bleeding complications (12% vs 46%, P < .001) compared to biopsies where the medulla was entered.DiscussionAn AOA of approximately 60°, aiming at the poles, and avoiding the medulla were each associated with fewer inadequate biopsies and bleeding complications. While biopsy of the medulla is necessary for some diagnoses, the increased bleeding risk emphasizes the need for communication between nephrologist, pathologist, and radiologist.     

Percutaneous Ultrasound-Guided Vacuum-Assisted Removal versus Surgery for Breast Lesions Showing Imaging-Histology Discordance after Ultrasound-Guided Core-Needle Biopsy

Objective

To evaluate the upgrade rate and delayed false-negative results of percutaneous vacuum-assisted removal (VAR) and surgical excision in women with imaging-histologic discordance during ultrasound (US)-guided automated core needle biopsy (CNB) of the breast and to validate the role of VAR as a rebiopsy method for these discordant lesions.

Materials and Methods

Percutaneous US-guided 14-gauge CNB was performed on 7470 patients between August 2005 and December 2010. Our study population included 161 lesions in 152 patients who underwent subsequent rebiopsy due to imaging-histologic discordance. Rebiopsy was performed using VAR (n = 88) or surgical excision (n = 73). We investigated the upgrade rate immediately after rebiopsy and delayed false-negative results during at least 24 months of follow-up after rebiopsy. We also evaluated the clinicoradiological differences between VAR and surgical excision.

Results

Total upgrade to malignancy occurred in 13.7% (22/161) of lesions at rebiopsy including both VAR and surgical excision: 4.6% (4/88) of VAR cases (4/88) and 24.7% (18/73) of surgical excision cases (p < 0.001). Surgical excision was performed significantly more frequently in older patients and for larger-sized lesions than that of VAR, and a significant difference was detected between VAR and surgical excision in the Breast Imaging and Reporting and Data System category (p < 0.007). No delayed false-negative results were observed after VAR or surgical excision during the follow-up period.

Conclusion

Long-term follow-up data showed no delayed cancer diagnoses after US-guided VAR in imaging-histologic discordant lesions of the breast, suggesting that VAR might be a rebiopsy method for these lesions.     

CT导向纵隔淋巴结针吸活检对肺癌的诊断意义

目的探讨CT导向纵隔淋巴结经皮针吸活检对支气管肺癌的诊断意义.方法1992-10～1998-09期间随机选择142例临床疑为原发性肺癌并有纵隔淋巴结增大(直径≥10mm)的病例,在CT扫描监控下,使用国产秦氏针进行185次针刺活检与细胞学检查.结果经手术(98例)、尸检(6例)与1年以上随访(25例)证实敏感性为82%,特异性为100%.结论CT导向经皮针刺纵隔淋巴结活检是一简便而又可靠的诊断方法,对支气管肺癌的诊断与分期有重要价值.     

Percutaneous Biopsy of Primary Soft Tissue Tumors

This article reviews the technique, results, and complications of percutaneous biopsies of soft tissue tumors. Biopsy of soft tissue tumors may be achieved either with fine needles or core-biopsy needles. The choice between the two biopsy techniques ultimately depends on the experience of the radiologist and pathologist. Since an inadequate technique may severely affect final treatment, the biopsy track should be discussed with the surgeon responsible for future management each time a primary tumor is suspected.     

Chest Wall Dissemination of Nocardiosis after Percutaneous Transthoracic Needle Biopsy

We described a case of chest wall dissemination after percutaneous transthoracic needle biopsy. A 65-year-old man had a lung nodule which was suspected to be lung carcinoma. He underwent percutaneous transthoracic needle biopsy using an 18G semiautomated biopsy needle and pathologic diagnosis showed organizing pneumonia. Two months after the biopsy, chest wall dissemination occurred. Implantation of carcinoma along the biopsy route was suspected, but the mass was actually due to pulmonary nocardiosis.     

肝脏恶性病变经皮穿刺不同活检方式比较

目的 探讨不同活检方式对肝脏恶性病变穿刺活检的价值.方法 105例肝脏恶性病变患者行B超或CT引导下肝脏病变穿刺活检术113次,其中57次行切割活检,40次行负压抽吸活检,16次应用同轴活检枪系统行切割加抽吸活检,分析不同穿刺活检方式的敏感性.不同穿刺活检方式与病理诊断敏感性之间的关系采用SPSS17.0软件进行x2检验分析,P＜0.05为有统计学意义.结果 所有病例一次穿刺成功率100％.无严重并发症发生.105例中穿刺诊断恶性病变88例,敏感性83.8％(88/105).切割穿刺活检敏感性82.5％(47/57),抽吸穿刺活检敏感性70.0％ (28/40),切割加抽吸活检敏感性81.3％(13/16).本组病例切割取材与抽吸取材敏感性比较P =0.149;切割加抽吸取材与抽吸取材敏感性比较P=0.390;切割取材与切割加抽吸取材敏感性比较P=0.911.不同穿刺活检方式与病理诊断敏感性之间统计学无显著性差异(P＞0.05).结论 不同活检方式对肝脏恶性病变穿刺活检的敏感性虽有差异,但差异无统计学意义,均有效可行.