低剂量多排螺旋CT导引经皮肺穿刺活检的临床应用

目的 比较低剂量CT与常规CT扫描导引经皮肺穿刺活检成功率,探讨低剂量 CT在胸部活检应用中的价值.方法 对96例肺部病变需要行经皮肺穿刺活检者,随机分组行多层螺旋CT的常规剂量(130 mA)和低剂量 CT(50 mA)扫描.经三维图像重建后导引穿刺活检.结果 低剂量多排CT与常规多排CT对肺部病变穿刺活检成功率经统计学检验无显著差别.两者穿刺成功率均达100%,诊断准确率达90%以上.结论 应用低剂量螺旋CT扫描导引肺穿刺活检,既可减少CT辐射剂量,而且具有快速等优点,值得临床推广使用.     

CT导引下经皮胸腹肿块穿刺活检

目的　总结CT导引下经皮胸腹肿块穿刺活检的应用及技术。方法　经皮穿刺活检 10 7例胸腹肿块 ,其中胸部病变 81例 ,腹部病变 2 6例。采用 18～ 2 0G福新针或 18G同轴自动切割针 ,常规选择“垂直床面进针”、“水平床面进针”或“垂直体廓一侧进针”的进针角度。结果　一次穿刺成功率 10 0 % ,总确诊率 92 .5 %。胸部并发症发生率 11.11% ,腹部未发现明显并发症。结论　CT导引下经皮胸腹肿块穿刺活检技术简单实用 ,准确度高 ,并发症少 ,运用时应强调有明确参照物的进针角度及针具的选择     

磁共振成像导航系统辅助经皮穿刺活检术的初步应用

目的 探讨MRI导航系统EMT-100辅助经皮精准穿刺活检术的有效性以及安全性.方法 使用MRI导航系统EMT-100辅助引导对42例胸、腹部病灶行经皮穿刺活检术.穿刺成功率作为有效性评价的主要依据,观察穿刺活检的成功率、总耗时、平均穿刺次数、平均扫描次数及并发症情况.结果 42例患者,1次穿刺成功率86％ (36/42),2次穿刺成功率14％(6/42),活检成功率100％;穿刺平均定位时间(11.5±5.5) min,平均穿刺次数(1.4±0.5)次,平均扫描次数(4.2±0.8)次,其中32例肺部病灶中2例(6.2％)痰中带血,1例(3.1％)少量气胸,其他患者均未出现严重并发症.结论 MRI导航系统辅助经皮穿刺活检术具有安全、定位准确、穿刺成功率高、适用范围广、无辐射等优点,为临床准确获取病变组织并获得病理诊断结果提供帮助,不失为一种有价值的导引技术选择.     

影像导航辅助定位穿刺系统在微创介入治疗中的应用

影像导航辅助定位穿刺系统是近年来发展的一项具有广阔应用前景的治疗新技术,它融合了影像与导航定位技术,通过影像显示实时动态导引手术器械对病灶进行操作,大大优化了微创介入治疗过程.影像导引方式主要包括超声、CT、MRI导引等,导航定位技术可根据不同原理分为机械定位、光学定位和电磁定位.不同影像引导方式和导航定位技术各有优劣.影像导航辅助定位穿刺系统目前已广泛应用于肿瘤穿刺活检、局部消融治疗、放射性粒子植入治疗等微创介入治疗领域,取得了良好效果,但仍存在一些不足.本文就该技术在微创介入治疗中的应用作一简要综述.     

超声与CT或MRI融合导航技术在介入诊疗中的临床应用

目的 评价超声(US)与CT或MRI融合导航技术在介入放射诊断和治疗中的作用.方法 回顾性分析47例接受US与cT或MRI融合导航技术行多种介入诊断和治疗患者的临床资料,包括操作方法、成功率、临床效果和并发症.对38例肝脏肿瘤行经皮穿刺活检和射频消融治疗;4例肝脓肿行经皮穿刺置管引流;5例骨骼及软组织病变行经皮穿刺活检和(或)射频消融、骨水泥填充治疗.结果 38例肝脏肿瘤行1次经皮射频消融治疗后,27例肿瘤达到了完全消融,随访3.0～6.0个月(中位随访时间4.8个月)无复发;11例在复查期内病灶范围未见明显变化.5例骨骼及软组织病变介入治疗效果显著,成功穿刺取材.4例肝脓肿经引流后痊愈.仅1例射频消融患者发生局部皮肤灼伤并发症,无其他操作相火并发症.结论 US与CT或MRI融合导航技术充分利用了多种影像手段的优势,提高了介入操作的定位准确性和安全性,扩大了介入诊断和治疗工作的应用范围.     

CT定位导向下软组织活检术的临床应用

目的探讨在CT导引下半自动活检枪经皮软组织活检术对病变的诊断价值及临床应用,提高CT导向经皮穿刺活检技术的水平。方法采用ToshibaXvision螺旋CT机和SiemensEmotion6型多层螺旋CT扫描仪及半自动活检枪(16G～22G),对100例胸、腹部占位性病变患者行CT导向经皮穿刺活检术。病灶直径1.5cm～11.7cm。结果99例患者穿刺成功,穿刺成功率为99%,其中,93例取得满意的细胞和组织学材料。本组患者均未发生与操作相关的严重并发症。结论CT导向经皮半自动活检枪穿刺活捡成功率和确诊率高,创伤小,并发症少,是胸、腹部占位性病变诊断及鉴别诊断的一种操作简便、安全可靠的检查方法。     

CT导引下经皮胸部穿刺活检的应用价值(附64例分析)

目的：探讨CT导引下经皮胸部穿刺活检的诊断价值。方法：64例病人，男38例，女26例，均采用18G抽吸针(Cook)，在CT导引下经皮穿刺活检，活检组织送病理。结果：除3例穿刺失败外，61例均穿刺成功，有4例并发少量气胸。穿刺成功率为95％，穿刺阳性诊断率为88％，并发症发生率为6％。结论：CT导引下经皮胸部穿刺活检安全、准确、易行，在胸部疾病的诊断和鉴别诊断方面起着重要的作用。     

影像融合导航技术在引导经皮肺穿刺活检中的精准性和可行性的实验研究

目的 探讨影像融合导航技术在引导经皮肺穿刺活检术中的精准性和可行性。方法 采用包含10个病灶的体外肺脏模型，在实时影像融合导航技术引导下行经皮肺穿刺活检的实验，共进行2次：1)2位操作者应用影像融合导航技术，各自独立完成对10个病灶模型的穿刺；2)1周后重复上述步骤。结果 2位操作者的总体穿刺成功率87.5%(35/40)，操作者A为90.0%(18/20),B为85.0%(17/20)，两者穿刺成功率差异无统计学意义（χ2=0.233,P=0.500）。在实验1与实验2中，操作者A与B的穿刺结果均具有较好的一致性（Kappa=0.773,P=0.016;Kappa=0.773,P=0.016）。结论 影像融合导航技术引导经皮肺穿刺活检定位精准，操作简单及可重复性强，可成为引导常规超声不能显示的肺部病变穿刺活检的重要手段。     

一次性活检装置在胸部活检穿刺中的临床应用

目的 :探讨一次性活检装置在胸部病变活检中的应用价值。方法 :应用BARD公司的18 G或20 G同轴定位针及配套同型号的一次性活检枪,对40例胸部病变患者,在CT引导下行穿刺活检及组织取材。结果:40例均成功穿刺,成功率100%,取材成功率97.5%(39/40);其中恶性病变34例,良性病变5例;气胸发生率10.0%(4/40),咯血发生率5.0%(2/40)。结论:使用一次性活检装置对胸部疾病诊断与鉴别,以及肿瘤的治疗具有指导意义,值得临床推广应用。     

Pinpoint CT立体定位激光导引系统的临床应用价值

目的：介绍Pinpoint立体定位激光导引系统在介入穿刺活检中的操作方法、经验体会及临床应用价值。方法：采用Marconi公司生产的PQ－6000高档螺旋CT主体扫描仪，在Pinpoint立体定位激光导引下对43例胸、腹部肿块患者实施经皮穿刺活检。结果：精确的三维立体激光定位使整个穿刺过程既轻松又安全，全部患者在Pinpoint系统的导引下均顺利地完成了穿刺活检手术，其穿刺准确率100％，活检成功率95.3%。结论：高档螺旋CT上配置Pinpoint3D立体激光定位系统是一种有避免射线损伤又可提高经皮穿刺精确性、安全性的理想导引技术，对提高临床诊断、治疗效果有广泛的应用价值。     

Sonographically Guided Core Biopsy of the Breast: Comparison of 14-Gauge Automated Gun and 11-Gauge Directional Vacuum-Assisted Biopsy Methods

Objective

To compare the outcomes of 14-gauge automated biopsy and 11-gauge vacuum-assisted biopsy for the sonographically guided core biopsies of breast lesions.

Materials and Methods

We retrospectively reviewed all sonographically guided core biopsies performed from January 2002 to February 2004. The sonographically guided core biopsies were performed with using a 14-gauge automated gun on 562 breast lesions or with using an 11-gauge vacuum-assisted device on 417 lesions. The histologic findings were compared with the surgical, imaging and follow-up findings. The histologic underestimation rate, the repeat biopsy rate and the false negative rates were compared between the two groups.

Results

A repeat biopsy was performed on 49 benign lesions because of the core biopsy results of the high-risk lesions (n = 24), the imaging-histologic discordance (n = 5), and the imaging findings showing disease progression (n = 20). The total underestimation rates, according to the biopsy device, were 55% (12/22) for the 14-gauge automated gun biopsies and 36% (8/22) for the 11-gauge vacuum-assisted device (p = 0.226). The atypical ductal hyperplasia (ADH) underestimation (i.e., atypical ductal hyperplasia at core biopsy and carcinoma at surgery) was 58% (7/12) for the 14-gauge automated gun biopsies and 20% (1/5) for the 11-gauge vacuum-assisted biopsies. The ductal carcinoma in situ (DCIS) underestimation rate (i.e., ductal carcinoma in situ upon core biopsy and invasive carcinoma found at surgery) was 50% (5/10) for the 14-gauge automated gun biopsies and 41% (7/17) for the 11-gauge vacuum-assisted biopsies. The repeat biopsy rates were 6% (33/562) for the 14-gauge automated gun biopsies and 3.5% (16/417) for the 11-gauge vacuum-assisted biopsies. Only 5 (0.5%) of the 979 core biopsies were believed to have missed the malignant lesions. The false-negative rate was 3% (4 of 128 cancers) for the 14-gauge automated gun biopsies and 1% (1 of 69 cancers) for the 11-gauge vacuum-assisted biopsies.

Conclusion

The outcomes of the sonographically guided core biopsies performed with the 11-gauge vacuum-assisted device were better than those outcomes of the biopsies performed with the 14-gauge automated gun in terms of underestimation, rebiopsy and the false negative rate, although these differences were not statistically significant.     

Positron emission tomography-CT imaging in guiding musculoskeletal biopsy

Positron emission tomography (PET)-computed tomography (CT) is a useful device in identifying musculoskeletal lesions that require biopsy. It can be used to localize the primary lesion, identify a site to biopsy, and evaluate metastatic lesions that require follow-up biopsies. Not all malignant tumors have hypermetabolic activity, and there are many benign lesions and physiologic processes that do have increased F-18 fluorodeoxyglucose uptake. Knowledge of these issues is important when reviewing PET-CT and directing subsequent musculoskeletal biopsies.     

Image-guided automated needle biopsy of 106 thoracic lesions: a retrospective review of diagnostic accuracy and complication rates

We reviewed the diagnostic accuracy and complication rates of transthoracic needle biopsy (TNB) with an automated 18-gauge core biopsy needle and gun, using either fluoroscopic or CT guidance. One hundred six lesions were biopsied in 103 patients between 1992 and 1998. Hard-copy images, imaging reports, pathology reports and clinical notes were reviewed. In 3 patients it was not possible to establish the lesion as either malignant or benign from the available follow-up, so these were removed from the analysis of diagnostic accuracy. Adequate samples for histological diagnosis were obtained in 104 of 106 (98 %) biopsies. There were 75 of 85 (88 %) true-positive core biopsies for malignant lesions and a specific cell type was identified in 70 of 85 (82 %) cases. A specific histological diagnosis was obtained in 12 of 18 (66 %) biopsies. There was a 19 % rate of pneumothorax with only 2.4 % requiring drainage. Minor haemoptysis occurred in 3.8 % of procedures. The TNB technique with an automated core biopsy needle provides a high level of diagnostic accuracy, effectively distinguishes cell type in malignancy and provides a definite diagnosis in benign disease more frequently than fine needle aspiration (FNA). There is no increased complication rate compared with FNA. Received: 26 January 1999; Revision received: 1 July 1999; Accepted: 2 July 1999     

Trends in recall, biopsy, and positive biopsy rates for screening mammography in an academic practice

PURPOSE: To retrospectively evaluate whether recall, biopsy, and positive biopsy rates for a group of radiologists who met requirements of Mammography Quality Standards Act of 1992 (MQSA) demonstrated any change over time during a 27-month period (nine consecutive calendar quarters). MATERIALS AND METHODS: Institutional review board approved study protocol, and informed consent was waived. All screening mammograms that had been interpreted by MQSA-qualified radiologists between January 1, 2001, and March 31, 2003, were reviewed. Group recall rates, biopsy rates, and detected cancer rates for nine calendar quarters were computed and attributed to performance date of original screening mammogram. Type of biopsy performed was classified as follows: stereotactic vacuum-assisted biopsy, ultrasonography (US)-guided core biopsy, US-guided fine-needle aspiration biopsy, surgical excision, and multiple biopsies. chi(2) Test for trend (two sided) and linear regression were used to assess trends over time for recall and biopsy rates, biopsy rates according to type of biopsy performed, and percentage of biopsy results positive for cancer. RESULTS: Group recall rate did not show a statistically significant trend during period studied (P = .59). Biopsy rates increased significantly from 13.02 to 20.12 per 1000 screening examinations (P < .001). A corresponding substantial decrease was seen in percentage of biopsies in which malignancy was found, although this trend was not statistically significant (P = .24). A significant increase (from 4.72 to 9.88 per 1000 screening examinations) was found in rate of stereotactic vacuum-assisted 11-gauge core biopsies performed (P < .001). CONCLUSION: Observed increase in biopsy rates reinforces the need to carefully select patients for biopsy to achieve efficient, efficacious, and cost-effective programs for early detection of breast cancers.     

Ultrasonography-guided percutaneous core biopsy in Achilles tendon disorder

Ultrasound-guided percutaneous core biopsy technique was studied in 15 consecutive patients with chronic Achilles tendon disorder defined as persisting local pain during daily activities, localized pain and swelling on palpation 2-5 cm proximal to the calcaneal insertion. Ultrasound verified widening of the tendon and low echogenous areas at the site of pain. Percutaneous biopsies were taken from both the low echogenous areas and the normoechogenic tendon tissue. Of 104 core biopsies 99 were representative. Open biopsies were taken from the macroscopically injured and normal tendon for comparison. Core and open biopsies of the low echogenous and macroscopically injured tendon showed similar histopatology. In 10 patients the core biopsy was performed under local anesthesia with limited subjective symptoms. Five of these patients were operated 18–41 days later. No adverse effect was found referring to the biopsy taken a few weeks prior to surgery. No complications occurred. We conclude that the percutaneous core biopsy, guided by ultrasound and performed under local anesthesia, can be used under clinical and experimental in vivo studies for improving knowledge on pathoanatomy and healing processes of the Achilles tendon.     

Comparison of automated versus vacuum-assisted biopsy methods for sonographically guided core biopsy of the breast

OBJECTIVE: The purpose of this study was to compare the outcome of sonographically guided core biopsies performed with the 14-gauge automated gun with the outcome of those performed with the 11-gauge vacuum-assisted device. Outcome was defined in terms of missed tumors, the need (both immediate and delayed) for a second biopsy, histologic underestimation, and complication rates. MATERIALS AND METHODS: We retrospectively reviewed all sonographically guided core biopsies performed between January 1997 and August 2001. Before February 2000, biopsies were performed using the 14-gauge automated gun and after that time, with either the 14-gauge automated gun or the 11-gauge vacuum-assisted device. During the study period, 181 biopsies were performed with the 14-gauge automated gun and 100 with the 11-gauge vacuum-assisted device. RESULTS: The histologic results of the core biopsies were similar for the group who underwent biopsy with the 14-gauge automated gun and the group who underwent biopsy with the 11-gauge vacuum-assisted device: malignant, 19% versus 19%; benign, 78% versus 79%; and high-risk lesion or other, 3% versus 2%, respectively (p > 0.7). Complications were rare and similar for both methods: 2% for the 14-gauge automated gun and 3% for the 11-gauge vacuum-assisted device (p = 0.46). A second biopsy was recommended immediately after the first in 14% of the patients who underwent biopsy with the 14-gauge automated gun versus 17% of those who underwent biopsy with the 11-gauge vacuum-assisted device (p = 0.47). Recommendation for delayed rebiopsy due to interval change occurred in 2.5% of the patients who underwent biopsy with the 14-gauge automated gun method and 3% of those who underwent biopsy with the 11-gauge vacuum-assisted device (p = 0.94). CONCLUSION: No significant differences were found in the outcomes of sonographically guided core biopsies performed with the automated gun compared with those performed with the vacuum-assisted device in terms of missed cancers, underestimation, complications, or the need (immediate or delayed) for a second biopsy.     

Percutaneous needle biopsy of the pleura

Percutaneous needle biopsy of the pleura and thoracic wall is a relatively simple, minimally invasive, and safe technique that may be performed in an outpatient setting under local anesthesia. Image guidance, combined with the use of core biopsy needles and immunohistochemical techniques, have lead to increased diagnostic yield and overall accuracy. Open and thoracoscopic biopsies are reserved for a minority of patients in whom pleural fluid cytology and percutaneous needle biopsy are nondiagnostic.     

Diagnostic Yield of Computed Tomography-Guided Coaxial Core Biopsy of Undetermined Masses in the Free Retroperitoneal Space: Single-Center Experience

The purpose of this study was to evaluate the diagnostic yield of core biopsy in coaxial technique under guidance of computed tomography (CT) for retroperitoneal masses. We performed a retrospective analysis of CT-guided coaxial core biopsies of undetermined masses in the non-organ-bound retroperitoneal space in 49 patients. In 37 cases a 15-G guidance needle with a 16-G semiautomated core biopsy system, and in 12 cases a 16-G guidance needle with an 18-G biopsy system, was used. All biopsies were technically successful. A small hematoma was seen in one case, but no relevant complication occurred. With the coaxial technique, up to 4 specimens were obtained from each lesion (mean, 2.8). Diagnostic accuracy in differentiation between malignant and benign diseases was 95.9%. A specific histological diagnosis could be established in 39 of 42 malignant lesions (92.9%). Correct subtyping of malignant lymphoma according to the WHO classification was possible in 87.0%. Benign lesions were correctly identified in seven cases, although a specific diagnosis could only be made in conjunction with clinical and radiological information. In conclusion, CT-guided coaxial core biopsy provides safe and accurate diagnosis of retroperitoneal masses. A specific histological diagnosis, which is essential for choosing the appropriate therapy, could be established in most cases of malignancy.     

Stromal fibrosis of the breast

OBJECTIVE: The purpose of this retrospective study was to describe the imaging features of stromal fibrosis of the breast and to determine the false-negative rate (number of cancers missed) at percutaneous biopsy. MATERIALS AND METHODS: Between January 1997 and October 1999, 1095 imaging-guided core biopsies were performed. Patients were included in our study if stromal fibrosis was the predominant histologic finding. Cores adjacent to previous excisional biopsies or from calcified lesions were excluded. RESULTS: Stromal fibrosis was diagnosed in 74 (6.8%) of 1095 imaging-guided core needle biopsies in 73 patients. The 10 mammographic lesions were variable in appearance. Most of the sonographic lesions were indeterminate, with 16 (25%) of 64 showing suspicious features. Discordant imaging resulted in three patients having a second core biopsy and nine patients having an excisional biopsy. The two false-negative findings were the result of an infiltrating lobular carcinoma and an infiltrating ductal carcinoma, the latter diagnosis delayed for 6 months. CONCLUSION: The low incidence (2.7%) of missed cancers in our series suggests that patients diagnosed at core biopsy as having stromal fibrosis can be treated conservatively with a short-term follow-up protocol. However, it would be prudent to continue to recommend either a second core biopsy or an excisional biopsy for imaging features that cannot be reliably differentiated from malignancy.     

Core biopsy of the bowel wall: efficacy and safety in the clinical setting

OBJECTIVE: The purpose of this study was to evaluate the efficacy and complications of percutaneous 18-gauge core biopsies of lesions of the bowel wall using CT and sonographic guidance. A retrospective study was made of 15 biopsy procedures performed on 12 patients with suspected neoplasia of the gastrointestinal tract. The biopsies were performed when there were no sites of metastatic disease more readily accessible to biopsy and the lesion was inaccessible to endoscopic techniques or when the endoscopic biopsy findings were negative. CONCLUSION: Three biopsy procedures provided inadequate samples and the biopsies were repeated, giving a total of 15 biopsy procedures. A tissue diagnosis was made in all 12 patients. All procedures were well tolerated, and no immediate or delayed complications occurred. Percutaneous core biopsy of bowel wall masses is a safe technique that allows a histologic diagnosis to be obtained in difficult cases when other methods cannot provide an adequate tissue sample.