CT导向下骨骼穿刺活检

目的：探讨CT导向下骨骼穿刺活检的方法，安全性及准确率，资料与方法：38例骨骼病变患者，脊柱16例，其他22例，分别在CT导向下行抽吸，切割或同轴式活检。结果：穿刺成功率为100％，准确率为92％，无严重并发症发生。结论：CＴ导向下骨骼穿刺活检安全有效，尤其对于脊柱等特殊部位应予采用。     

超细支气管镜结合经皮肺穿技术在肺外周病变诊断中的价值

目的 评价超细支气管镜结合经皮肺穿技术在肺外周病变诊断中的价值.方法 269例肺外周病变患者均先进行超细支气管镜活检并刷检术,对无阳性结果,且病灶位于肺门、内带或中带的89例患者进行X线引导超细支气管镜肺活检并刷检术;对病灶位于中、外带的77例患者,经X线引导进行经皮肺穿刺针吸活检术;对于超细病灶紧贴胸壁的70例患者经B超引导进行经皮肺自动弹性穿刺切割活检术.结果 269例患者行超细支气管镜肺活检并刷检共276例次,获得诊断者82例,阳性率为30.5%(82/269);89例患者行X线引导超细支气管镜肺活检并刷检94例次,获得诊断者66例,阳性率为74.2%(66/89);77例患者行X线引导经皮肺针吸活检85例次,获得诊断者52例,阳性率为67.5%(52/77);70例患者行B超引导经皮肺自动弹性穿刺切割术79例次,获得诊断者49例,阳性率为70.0%(49/70).4种方法结合后的诊断率(92.6%)明显提高.结论 综合超细支气管镜检查结合经皮肺穿等介入诊断技术,可明显提高肺外周病变的阳性率,值得临床推广应用.     

Incidental treatment of nipple discharge caused by benign intraductal papilloma through diagnostic Mammotome biopsy

OBJECTIVE: The purpose of this study was to evaluate imaging-guided vacuum-assisted mammotome biopsy as a minimally invasive method of obtaining a satisfactory diagnosis and eliminating the bothersome symptoms in patients presenting with nipple discharge. MATERIALS AND METHODS: Forty-nine women who presented with nipple discharge and who had final pathologic diagnoses of papillary lesions were retrospectively identified. Fifty-six lesions were biopsied in this group. The examinations included mammography, ductography, sonography, and, if possible, percutaneous biopsy. All lesions were centrally located and most were superficial. Of this study group, four patients with five lesions proceeded to sonographically guided automated core biopsy, and 38 patients with 44 intraductal lesions identified by sonography advanced to sonographically guided biopsy with an 11-gauge mammotome probe. One patient underwent stereotactic 11-gauge mammotome biopsy. Patients not advancing to sonographically guided biopsy were those with masses either in the nipple or nipple-areolar complex (five patients), one patient with no identifiable lesion at sonography, and one directly referred for open surgical biopsy. RESULTS: In all biopsied patients, satisfactory tissue for diagnosis was obtained. In patients biopsied with the mammotome probe, follow-up at a mean time of 13 months revealed resolution of the presenting problematic discharge in 97.2% of patients. Complications were mild and infrequent. Only one of 50 percutaneously biopsied lesions was not benign and required subsequent surgery. CONCLUSION: Papilloma excision with percutaneous biopsy allows safe and accurate tissue analysis and a high probability of terminating the symptomatic nipple discharge.     

颞下间隙病变磁共振导引下经皮活检术

目的 研究颞下间隙病变磁共振(MR)导引下经皮活检术的临床应用。方法 借助开放式0．2T MR对7例颞下间隙肿块病灶进行穿刺活检。结果 磁共振导引下经皮活检靶中率100％，活检正确率85．7％，无并发症出现。结论 磁共振导引下经皮活检术有助于颞下间隙病变的诊断。     

Sonographically guided directional vacuum-assisted breast biopsy: preliminary experience in Venezuela.

OBJECTIVE: The purpose of this study was to evaluate the use of sonographically guided directional vacuum-assisted biopsy in the histologic diagnosis of breast lesions. MATERIALS AND METHODS: Eighty-eight lesions in 83 women underwent sonographically guided 11-gauge directional vacuum-assisted breast biopsy during a 26-month period. Biopsies were performed using high-resolution sonography equipment with a 7.5-MHz transducer, obtaining a median of 17 specimens per lesion. Imaging studies, medical records, and histologic findings were reviewed. RESULTS: Median patient age was 48 years (range, 25-78 years). Median lesion size was 1.2 cm (range, 0.4-2.5 cm). Twenty-four (27.3%) of 88 lesions were palpable. The median time required to perform biopsy was 17 min (range, 10-40 min). Complete removal of the lesion seen at sonography occurred in 78 (88.6%) of 88 lesions and was significantly more frequent in lesions measuring 1.5 cm or less than in larger lesions (68/71 = 95.8% vs 10/17 = 58.8%,p < 0.0003). A surgical procedure was spared in 79 (95.2%) of 83 women. In 36 lesions with imaging and clinical follow-up after sonographically guided biopsy with benign findings (range, 4-24 months; median, 11.3 months), we found no evidence of cancer or scarring in the breast. CONCLUSION: In our small series, sonographically guided directional vacuum-assisted biopsy was a fast and accurate method for breast diagnosis. This technique resulted in complete removal of 95.8% of lesions shown at sonography measuring 1.5 cm or less and spared a surgical procedure in 95.2% of women. Further work is necessary to refine indications, evaluate cost-effectiveness, and assess long-term outcome.     

CT引导纤维支气管镜对小支气管源性癌的活检价值

目的：探讨CT引导纤维支气管镜(纤支镜)对小支气管源性癌的活检价值。方法：33例CT引导纤支镜活检结果与手术病理对照并与纤支镜盲检及CT引导经皮肺穿刺活检比较。结果：单纯1～3级大支气管内病变，可采用纤支镜直视活检；小支气管内病变以CT引导纤支镜活检更为可靠、准确和并发症少；细支气管及肺泡病变则以CT引导经皮肺穿刺活检成功率高。结论：对发生于小支气管内的较小病灶，CT引导纤支镜活检，可以采集到更全面的病理标本，并通过镜检 刷检 多点活检技术的综合应用，能进一步提高活检的准确性。     

Freehand iMRI-guided large-gauge core needle biopsy: a new minimally invasive technique for diagnosis of enhancing breast lesions

The lack of reliable methods for minimally invasive biopsy of suspicious enhancing breast lesions has hindered the utilization of contrast-enhanced magnetic resonance imaging (MRI) for the detection and diagnosis of breast cancer. In this study, a freehand method was developed for large-gauge core needle biopsy (LCNB) guided by intraprocedural MRI (iMRI). Twenty-seven lesions in nineteen patients were biopsied using iMRI-guided LCNB without significant complications. Diagnostic tissue was obtained in all cases. Nineteen of the 27 lesions were subsequently surgically excised. Histopathologic analysis confirmed that iMRI-guided LCNB correctly distinguished benign lesions from malignancy in 18 of the 19 lesions. The histology revealed by core biopsy was partially discrepant with surgical biopsy in 2 of the other 19 lesions. Freehand iMRI-guided LCNB of enhancing breast lesions is promising. Larger studies are needed to determine the smallest lesion that can be sampled reliably and to precisely measure the accuracy of iMRI-guided LCNB as a minimally invasive tool to diagnose suspicious lesions found by breast MRI. J. Magn. Reson. Imaging 2001;13:896-902.     

Sonographically guided directional vacuum-assisted breast biopsy using a handheld device.

OBJECTIVE: The goal of this study was to show that one can safely remove all sonographic evidence of masses in the breast less than or equal to 1.5 cm in greatest dimension using the 11-gauge handheld Mammotome, thereby reducing the possibility of a false-negative diagnosis and other shortcomings of the automated core biopsy device. SUBJECTS AND METHODS: Over a 12-week period (May 3--July 31, 2000), 124 sonographically guided breast biopsies were performed in 113 patients, using a new handheld directional vacuum-assisted biopsy device. All lesions that were less than or equal to 1.5 cm were biopsied using a handheld Mammotome; an attempt was made to continue the biopsy until no sonographic evidence of the lesion remained. RESULTS: Of these 124 lesions, 14 had infiltrating ductal carcinomas, four had infiltrating ductal carcinomas with associated ductal carcinoma in situ, one had infiltrating lobular carcinoma, one had ductal carcinoma in situ, three had atypical ductal hyperplasias, one had atypical lobular hyperplasia, and one had phyllodes tumor. Only one infiltrating ductal carcinoma was entirely removed histologically at Mammotome biopsy. There were no underestimates of disease. No cases of epithelial displacement were observed in any of the surgical excisions of malignancies. The remaining 99 lesions were benign. CONCLUSION: The handheld Mammotome diminishes the shortcomings of the automated core biopsy device. It reduces the possibility of false-negatives and underestimation of disease. It eliminates the need for multiple insertions and reduces the likelihood of epithelial displacement. As a result, we now use this device for all sonographically guided biopsies of breast masses smaller than 1.5 cm and recommend that others consider it for such use.     

CT引导下经皮肺穿刺活检的临床应用与结果分析

目的总结CT引导下经皮肺穿刺活检术的临床应用。方法采用GE—Hispeed螺旋CT机，各种型号病理穿刺针及切割针对36例胸部占位性病变，实施CT引导下经皮穿刺活检术。结果病灶直径1．5cm～10cm大小，平均3．5cm。穿刺成功35例，活检阳性率100％，并发症有气胸3例，咯血1例，术后经抗炎及止血处理，气胸很快吸收，咯血停止。结论CT引导下经皮肺穿刺活检术成功率高，并发症少而轻，对胸部占位性病的定性诊断具有重要的临床意义。     

CT导引下椎体穿刺活检

目的：评价ＣＴ导引下椎体穿刺活检对诊断的意义和价值。材料与方法：３６例椎体活检，包括颈椎２例、胸椎１１例、腰椎２１例和骶椎２例。活检时病人体位为俯卧位，穿刺针为Ａｃｋｅｒｍａｎｎ针，有时辅以抽吸针。结果：刺中率为１００％，正确率为８８．６％，假阴性为１１．４％。本组未出现并发症。结论：ＣＴ导引下椎体穿刺活检是一种简便、正确率高的诊断和鉴别诊断的有效方法。     

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。     

Ultraschallgezielte Stanzbiopsie der Mamma: Technik,Ergebnisse, Indikationen

Purpose. The purpose of this retrospective analysis was to assess the diagnostic accuracy and complication rate of sonographically guided core needle biopsy in palpable breast masses, mammographically detected nonpalpable lesions, and sonographically detected clinically and mammographically occult lesions. Patients and methods. Sonographically guided core needle biopsy was performed in 590 lesions in 572 patients, by using an automated biopsy gun with a 14-gauge large core needle and a coaxial system. Core needle biopsy results were compared with surgical biopsy in 265 cases. 325 lesions with benign histologic diagnoses were followed up for at least 18 months. Results. 234 carcinomas and 356 benign abnormalities were found in the 572 patients. Core needle biopsy reached a sensitivity of 98.7% at a specificity of 99.7%. Understimation rates for lesions initially diagnosed as DCIS and for lesions initially diagnosed as ADH were 3/10 and 6/14, respectively. Of three false-negative results, two were immediately recognized, and one was identfied at follow-up. Serious bleeding occured in one patient (0.2% complication rate). Conclusions. This report confirms that sonographically guided large core needle biopsy is a safe, reliable and cost-effective method for the assessment of both palpable and nonpalpable, mammographically and sonographically detected breast abnormalities.     

Peripheral pulmonary lesions: ultrasonography and ultrasonically guided aspiration biopsy

Twenty-five patients, each of whom had peripheral intrathoracic lesions that were smaller than 5.0 X 5.0 cm in size and not diagnosed by conventional methods, underwent real-time sonography and ultrasonically guided aspiration biopsy. The lesions included 18 nodules, two infiltrates, and five cavitary lesions. Sonography showed homogeneous hypoechoic or isoechoic density with well-defined margins in 16 of the nodules, and heterogeneous echogenicity with irregular margins in infiltrates. The cavitary lesions showed a hyperechoic ring with a central sonolucent area. Biopsy specimens were successfully obtained by percutaneous aspiration under ultrasound guidance in 24 (96%) of the patients, and a positive diagnosis was established in 21 (84%) by cytology and/or histology. All 17 malignant lesions were diagnosed by aspiration biopsy, while only four of seven benign lesions were diagnosed by this method. Two patients (8%) experienced minimal pneumothorax after aspiration biopsy. We conclude that real-time sonography, including ultrasonically guided aspiration biopsy, is a useful and safe method for examination of peripheral intrathoracic lesions and has a high diagnostic yield.     

CT引导下寰枢椎病变经皮穿刺活检

目的 全面系统地探讨寰枢椎病变CT引导下穿刺活检的入路选择,评价其安全性及临床应用价值。材料与方法 25例寰枢椎病变行CT引导下经皮穿刺活检。穿刺部位包括C1及C2椎体的各个部位。根据病变的部位不同,设计相应的进针路径,穿刺取材。结果 25例中,24例获得明确病理诊断,穿刺活检准确率96％。其中12例手术治疗,穿刺病理与手术病理符合率100％。无并发症发生。结论 寰枢椎病变解剖关系复杂,毗邻脊髓及重要的大血管,选择适宜的穿刺路径尤为关键。寰枢椎病变不同的穿刺路径,只要避开大血管及脊髓,操作是比较安全的。为临床确定治疗方案提供了必要的病理依据。     

Imaging-guided core needle biopsy of papillary lesions of the breast

OBJECTIVE: Our objective was to assess the incidence of papillary lesions of the breast diagnosed at imaging-guided core needle biopsy and the need for surgical excision after a benign diagnosis. MATERIALS AND METHODS: This retrospective study included 1374 patients with consecutive suspicious breast lesions that underwent either mammography or sonographically guided large-core needle breast biopsy. Fifty-seven lesions (4%) were classified as papillary lesions. Eleven of the 57 cases were lost to follow-up (n = 6) or had not yet shown 2 years of stability (n = 5) and were excluded from this study. The remaining 46 papillary lesions constitute our study population. RESULTS: Surgical excision was performed in 17 (37%) of 46 papillary lesions. In the group of patients whose lesions were recommended for excision because carcinoma was identified at core biopsy, surgical excision revealed one false-positive and two true-positive diagnoses. In four cases, histologic diagnoses of the excisional biopsy and the core needle biopsy were discordant. One false-positive finding at core needle biopsy initially was interpreted as invasive ductal carcinoma on the basis of core needle biopsy specimens. In three false-negative findings, the initial diagnosis at core needle biopsy was upgraded after surgical excision. Two cases of papilloma with adjacent atypical ductal hyperplasia and one of atypical papilloma were upgraded to ductal carcinoma in situ after surgical excision. Imaging follow-up was performed in the remaining 29 patients. All lesions were stable or had decreased in size during the 2-year follow-up period. The negative predictive value of core needle biopsy for excluding malignancy among the papillary lesions diagnosed in our study was 93%. CONCLUSION: When the histologic diagnosis is benign, our data suggest that papillary lesions may be safely managed with imaging follow-up rather than with surgical excision. However, atypical papillary lesions or those associated with atypia require surgical excision because histologic underestimation occurs at a frequency similar to that in other atypical lesions undergoing core needle biopsy.     

CT导向肌骨病变穿刺活检

介绍ＣＴ导向肌骨病变穿刺活检。材料与方法：７０例患者在ＣＴ引导下作穿刺活检，其中骨骼６３例，软组织７例，采用钻骨针，切割针抽吸和其他方法活检。结果所有病列均获得突刺成功，阳性率为９１．４％，假阴性率８．６％，未发生并发症。结论：ＣＴ导向肌骨病变穿刺活检是安全，有效地诊断方法，ＣＴ的准确定位和选择最佳技术是提高活检成功率的关键。     

MR-guided bone biopsy: preliminary report of a new guiding method.

PURPOSE: To evaluate the feasibility of a new MR compatible optical tracking guided bone biopsy system. MATERIALS AND METHODS: Wireless optical tracker elements were connected to a bone biopsy set. Biopsies of five different anatomic areas and lesions varying from 9 mm to 40 mm (mean 25 mm) in size, were performed. RESULTS: We were able to perform the biopsies in all cases, and the samples allowed for a pathologic diagnosis. The procedure time was limited to less than 40 minutes, and no complications occurred. CONCLUSION: MR-guided bone biopsy with this new guiding system was a feasible and fast procedure that did not compromise the usability of the bone biopsy set.     

Breast lesions with imaging-histologic discordance during US-guided 14G automated core biopsy: can the directional vacuum-assisted removal replace the surgical excision? Initial findings

The purpose of this study was to determine the frequency of carcinoma at percutaneous directional vacuum-assisted removal (DVAR) in women with imaging-histologic discordance during ultrasound (US)-guided automated core needle biopsy, and to determine the role of DVAR in breast lesions with imaging-histologic discordance. A US-guided 14-gauge automated core needle biopsy was performed on 837 consecutive lesions. Imaging-histologic discordance was prospectively considered in 33 of 634 benign biopsies. DVAR was recommended in those lesions. Among the 33 lesions, 26 lesions that underwent subsequent DVAR or surgical excision made up our study population. Medical records, imaging studies, and histologic findings were reviewed. Among the 26 lesions, 18 lesions underwent subsequent US–guided DVAR, with 8-gauge probes for 15 of the lesions, and 11-gauge for three of the lesions. Two lesions were diagnosed as having carcinoma (2/18, 11.1% of upgrade rate; 3.1–32.8% CI). The remaining eight lesions underwent subsequent surgical excision, and carcinoma was diagnosed in one case (12.5% of upgrade rate; 2.2–47.1% CI). A US-guided DVAR of the breast mass with imaging-histologic discordance during US-guided 14-gauge automated core needle biopsy is a valuable alternative to surgery as a means of obtaining a definitive histological diagnosis. An erratum to this article can be found at     

CT-guided cutting needle biopsy of lung lesions--an effective procedure for adequate material and specific diagnose

Objective

Computed guided percutaneous biopsy of lung lesions is widely accepted as an effective and safe procedure for specific diagnose. The purpose of this study is to present the experience of an oncology center in the use of computed tomography (CT)-guided cutting needle biopsy as an effective procedure for adequate material and specific diagnose of lung lesions.

Subjects and methods

This study reports a retrospective analysis of 94 consecutive patients admitted in an oncologic center, reference in Brazil (Hospital do Câncer—AC Camargo), between 1996 and 2004, who were submitted to 97 CT guided cutting needle biopsy of pulmonary lesions. Informations of material adequacy and specific diagnose were studied.

Results

In a total of 97 biopsies of lung lesions, 94 (96.9%) supplied adequate material for histological analyses with 71 (73.2%) as malignant lesions and 23 (23.7%) diagnosed as benign lesions and in 3 biopsies the material supplied was inadequate. The frequency of specific diagnosis was higher in both malignant and benign lesions with 63 (88.7%) cases and 20 (86.7%) cases respectively.

Conclusions

CT-guided cutting needle biopsy is an effective procedure for adequate material and specific diagnostic for malignant and benign lung lesions.     

Oblique approach of computed tomography guided needle biopsy using multiplanar reconstruction image by multidetector-row CT in lung cancer

The purpose of this study was to establish the technique of multiplanar reconstruction (MPR) with multidetector-row (MDR) computed tomography (CT) guided needle biopsy for the diagnosis to access very difficult lesions. The CT guided percutaneous biopsy are well-established methods to obtain cytological and histological material such as the peripheral tumors in lung cancer. Occasionally, the conventional CT cannot permit planning a trajectory to avoid passage through bones, avoidance of bullae, fissures or vessels. In addition, some lesions are situated in less favorable locations such as those in the costophrenic recess or close to the mediastinum. Rarely can we diagnose them. MPR with MDR-CT has recently become widely available with applications for thoracic lesions. MPR images have been used to evaluate the location of small peripheral lung nodules to the relation of bullaes, vessels, and costophrenic recess. To diagnose these lesions, the usefulness of MPR were evaluated for an planning of an oblique approach of CT guided needle biopsy. MPR images were reconstructed as a line from the needle entry point to the target lesion. The first oblique image applied as the direction of posterior-anterior and cranio-caudal axis, and the second oblique image applied as the direction of posterior-anterior and left-right. Eleven out of 151 patients were required MPR technique to allow possible access to target, because of avoidance of bone and fissures in the needle pass or located in the costophrenic recess, between April 2001 and December 2002. The 5/11 patients were at the upper site (segment 1, 2 and 6) behind the scapula and ribs, 3/11 patients were at the lower lobe (segment 10) in the costophrenic recess, and 3/11 were middle lobe or segment 3 covered by the ribs and fissures. All the lesions except one were histologically diagnosed. Five patients were adenocarcinoma, and the other five patients were benign tumors. Pneumothorax occurred in one patient before we obtained the specimens. MPR guided needle biopsy with oblique approach was thought to be useful for diagnosis of very difficult thoracic lesions and would obviate an unnecessary surgical thoracoscopy.