CT引导下经皮穿刺同轴细针活检术诊断纵隔占位性病变40例

目的 评价CT引导下经皮穿刺同轴细针活检术对纵隔占位性病变诊断的技术成功率、诊断正确率和安全性.方法 在CT引导下采用18G带芯穿刺针穿刺40例纵隔占位性病变,然后经18G穿刺针的外套针同轴引入20 G切割活检细针对纵隔病变行经皮同轴穿刺活检.结果 40例患者的纵隔占位性病变接受41次活检,其中1例患者先后接受2次穿刺活检.CT证实41次经皮穿刺的穿刺针皆位于纵隔占位病灶内,37次活检病理结果与临床最终诊断相一致.本组资料穿刺技术成功率100％,穿刺活检诊断准确率90.2％.2例出现少量气胸,肺组织压缩程度小于20％,随访过程中自行吸收,无其他穿刺相关并发症发生.结论 CT引导下经皮同轴穿刺活检术诊断纵隔占位性病变是安全、准确、微创的介入诊断技术.     

Ultrasonically guided percutaneous fine needle aspiration biopsy of solid masses

Fine needle aspiration biopsy is a highly accurate cytologic technique in the differentiation of benign vs. malignant disease. After careful localization with the ultrasound beam, a 22 gauge 0.6 mm needle is used to obtain four to five cell samples. Seventy percutaneous fine needle aspiration biopsies were performed nodes, subcutaneous nodules, and other retroperitoneal masses. Ninety-three percent accuracy was obtained with no complications. Studies in four patients with carcinoma of the tail of the pancreas were falsely negative for malignant cells; all four patients had desmoplastic tumors. Complications of hemorrhage, tumor seeding, infection, fistula formation, and pain encountered with other methods and using larger bore needles have not been found with the fine needle technique. It is a safe, accurate method that can be performed as an out-patient procedure.     

CT-guided cutting needle lung biopsy using modified coaxial technique: factors effecting risk of complications

Purpose

We present our 7-year experience with coaxial computed tomography (CT)-guided cutting needle lung biopsy and evaluate the factors affecting risk of complications.

Material and method

Between June 2000 and March 2007, we performed 225 CT-guided coaxial lung biopsies in 213 consecutive patients (161 men, 52 women). Lesion size, lesion depth, lesion location, needle-pleural angle, presence of pleural effusion, patient's position, and complications secondary to biopsy procedure (pneumothorax and bleeding) were noted. Pneumothorax was graded as mild, moderate, and severe. Bleeding complications were graded as mild, moderate, and severe.

Results

Two hundred twenty-five biopsy procedures were performed in 213 patients. The mean diameter of the lung lesion was 41.3 ± 20.1 mm. The mean distance from the peripheral margin of the lesion to the pleura was 17.3 ± 19.2 mm. After 225 procedures, there were 42 mild (18.6%), 13 moderate (5.7%), and 4 severe (1.7%) pneumothoraxes. Small hemoptysis occurred in 27 patients (12%), and mild parenchymal hemorrhage occurred in 2 patients (0.8%). The overall complication rate was 39.1%. Although, a statistically significant correlation was found between female sex, presence of emphysema, lesion depth, and pneumothorax, none of these factors had a predictive value for pneumothorax. Although, statistically significant correlations were found between female sex, lesion size, and bleeding, only lesion size had a predictive value for bleeding.

Conclusion

The most frequent and important complications of this procedure are pneumothorax and bleeding. But any factor is the predictor of pneumothorax and lesion depth is a poor predictor of bleeding complication.     

Percutaneous coaxial needle biopsy using the spacer technique: a novel and easy modification to increase procedure safety

We describe a novel but easy modification to percutaneous coaxial needle biopsy technique using readily available standard equipment to enable a predefined variable sampling length to be achieved. This technique involves the insertion of a carefully measured spacer between the coaxial cutting needle and guide needle. This can minimise the sampling length required to biopsy any given lesion, minimising the volume of traumatised tissue and preventing unnecessary penetration of tissues deep to smaller lesions, thus increasing procedure safety.     

Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy in cavitary pulmonary lesions

Objective

CT-guided transthoracic biopsy is a well-established method in the cytologic or histologic diagnosis of pulmonary lesions. The knowledge of its diagnostic performance and complications for cavitary pulmonary lesions is limited. The purpose of this study was to determine the diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy (FNAB) in cavitary pulmonary lesions.

Materials and methods

102 consecutive patients with pulmonary cavitary lesions received CT-guided FNAB with use of an 18-gauge (n = 35) or 20-gauge (n = 67) Chiba for histology diagnosis. The sensitivity, specificity, and diagnostic accuracy of FNAB were calculated as compared with the final diagnosis. Complications associated with FNAB were observed. The diagnostic accuracy and complications were compared between patients with different lesion sizes and different cavity wall thickness.

Results

The overall sensitivity, specificity, and accuracy of FNAB were 96.3%, 98.0%, and 96.1%, respectively. The sensitivity, specificity, and diagnosis accuracy in different lesion size (<2 cm vs ≥2 cm), or different cavity wall thickness (<5 mm vs ≥5 mm) were not different (P > 0.05; 0.235). More nondiagnostic sample was found in wall thickness <5 mm lesions (P = 0.017). Associated complications included pneumothorax in 9 (8.8%) patients and alveolar hemorrhage in 14 patients (13.7%) and hemoptysis in 1 patient (1%). No different rate of complications was found with regard to lesion size, wall thickness, length of the needle path and needle size (P > 0.05).

Conclusion

CT-guided FNAB can be effectively ad safely used for patients with pulmonary cavitary lesions.     

Comparison of stereotactic fine needle aspiration cytology and core needle biopsy in 522 non-palpable breast lesions

Purpose: 
To compare the accuracy of stereotactic fine needle aspiration cytologies (S-FNAC) and stereotactic core needle biopsies (S-CNB) in non-palpable breast lesions. Material and Methods: 
Between May 1993 and December 2000, 696 patients with mammographically detected lesions were biopsied both with S-FNAC and S-CNB. S-FNAC was performed with spinal needle 22- or 20-gauge and S-CNB with an automated 14-gauge gun. Results: 
Of the 696 patients, 522 (75%) underwent breast surgery with postoperative histopathology. In all, 448 of these 522 women (86%) had malignant and 74 (14%) had benign lesions. S-FNAC revealed cancer in 254 (57%) and probable cancer in 48 (11%) (sensitivity 68%, specificity 99.6%) and S-CNB revealed cancer in 388 (87%) and probable cancer in 18 (4%) (sensitivity 90%, specificity 98.8%) of these 448 patients. Conclusion: 
S-CNB was more accurate than S-FNAC in the diagnosis of non-palpable breast cancer.     

Image-guided coaxial fine needle aspiration biopsy with a side-exiting guide

PURPOSE: The aim of this study was to evaluate the diagnostic accuracy and complication rates of a side-exiting coaxial needle system for fine needle aspiration (FNA) biopsies. METHOD: Between 1995 and 1998, 127 nonconsecutive biopsies were performed on 122 patients (74 males, 48 females). CT guidance was used in 111, ultrasound guidance was used in 14, and both were used in 2 biopsies. Patient history, biopsy site, needle performance, complications, and cytology results were recorded. RESULTS: Diagnostic rate and accuracy were 92.9 and 99.2%, respectively. There were minor complications from 14 biopsies, and all of them arose from chest biopsies: pneumothorax in 13 of 47 and hemoptysis in 1 of 47. There were no major complications. CONCLUSION: The side-exiting coaxial needle system is a safe and effective alternative to the conventional end-exiting coaxial needle system for performance of image-guided FNA biopsies.     

CT-guided transthoracic cutting needle biopsy of intrathoracic lesions: comparison between coaxial and single needle technique

Purpose

To evaluate the complication rates and diagnostic accuracy of two different CT-guided transthoracic cutting needle biopsy techniques: coaxial method and single needle method.

Methods

This study involved 198 consecutive subjects with 198 intrathoracic lesions. The first 98 consecutive subjects received a single needle cutting technique and the next 100 consecutive subjects received a coaxial technique. Both groups were compared in relation the diagnostic accuracy and complication rates.

Results

No significant difference was found between the two groups concerning patient characteristics, lesions and procedure variables. There was a borderline statistical difference in the incidence of pneumothorax at within 24-h post biopsy between patients in the single needle group (5%) and the coaxial group (13%) (P = 0.053). Little difference was found in the pneumothorax rate at immediately post biopsy between the two groups, which was 28% in the single needle group and 31% in the coaxial group. There was no significant difference in the hemoptysis rate between the two groups, which was 9.2% in the single needle group and 11% in the coaxial group. Both techniques yielded an overall diagnostic accuracy of 98% for malignant lesions with similar sensitivity (single needle: 96.9% vs. coaxial: 96.4%) and specificity (single needle: 100% vs. coaxial: 100%).

Conclusion

There is little difference in the pneumothorax rates and bleeding complications between patients who either received a single needle or a coaxial transthoracic cutting biopsy. Both techniques produce an overall diagnostic accuracy of 98% for malignant lesions.     

新型同轴技术在前中纵隔肿块穿刺活检术中应用

目的 评价新型同轴技术在CT引导下经胸骨路径前中纵隔肿块穿刺活检术中的临床应用.方法 2014年6月-2015年6月共21例接受CT引导下经胸骨前中纵隔肿块穿刺活检术患者.先应用14 G Bonopty骨穿刺套针穿刺建立同轴,再用18G安捷泰穿刺活检针或全自动切割针沿同轴行旋切负压抽吸或切割,取穿刺组织满意后,送病理检查.结果 2例患者因第一次取材较少行第2次穿刺活检术.穿刺病理结果为胸腺瘤11例(A型l例,AB型3例,B1型1例,B2型3例,B3型1例,胸腺癌2例),良性胸腺增生1例,淋巴瘤5例,纵隔型鳞癌3例,纵隔型神经内分泌癌l例.恶性肿瘤诊断的灵敏度88.19％(16/18),阳性预测值100％(16/16),无假阳性.良性病变诊断的特异性3/3,阴性预测值3/5,总的诊断准确率90.5％％(19/21).术后并发症:出血2例,均为极少量.无需处理.结论 CT引导下经胸骨同轴穿刺前中纵隔肿块活检,准确性较高、并发症发生率低,值得应用.     

A device for CT-guided needle punctures: Technical note

A device is presented to increase placement accuracy and to reduce localization scans during CT-guided biopsies. The device provides an accurate anticipation of the needle path by external radiopaque landmarks.     

Percutaneous biopsy and drainage procedures in the abdomen using a modified coaxial technique

A modified coaxial technique for biopsy and drainage procedures in the abdomen is described. This technique involves initial placement of a 23-gauge needle into an abdominal organ or mass. Once proper position is obtained, the hub of the needle is removed and a 19-gauge or larger needle is placed over the 23-gauge needle. Through this larger needle, either multiple biopsies are performed or guidewire exchange for a larger catheter is accomplished. The technique was used in performance of seven biopsy procedures, one biliary drainage procedure, and three nephrostomies.     

超声引导下甲状腺结节细针穿刺及量化分级系统的临床价值

目的探讨甲状腺超声量化分级系统和超声引导下细针穿刺抽吸活检（US-FNAB）对甲状腺结节的临床应用价值。方法回顾性分析US-FNAB且手术病理证实的260例患者甲状腺结节285个,将甲状腺结节按超声量化分级系统进行分级,将分级结果及US-FNAB细胞学结果与手术组织学结果进行对照。结果超声量化分级系统的敏感度为87.7%（200/228）、特异度为61.4%（35/57）、阳性预测值为90.1%（200/222）、阴性预测值为55.6%（35/63）、准确率为82.5%（235/285）。US-FNAB的敏感度为88.2%（201/228）、特异度为77.2%（44/57）、阳性预测值为93.9%（201/214）、阴性预测值为62.0%（44/71）、准确率为86.0%（245/285）。US-FNAB诊断甲状腺阴性结节71个,按3级、4A、4B及5级分类其恶性率分别为0.0%、16.7%、56.5%及58.8%。US-FNAB假阳性结果13个中超声阳性5个,超声阴性8个。US-FNAB假阴性结果27个中超声阳性23个,超声阴性为4个。结论超声量化分级系统与US-FNAB对甲状腺结节具有较高的诊断价值,超声量化分级系统可作为进行US-FNAB的准入指标,同时可对部分结节穿刺后临床处理提供指导作用。     

乳腺X线立体定位细针活检的操作体会

目的：探讨乳腺X线立体定位细针活检（SNLB）的操作技术和注意事项。方法：回顾性总结分析对46例患者行SNLB检查的步骤、方法。结果：46例患者中，恶性病变24例。良性病变22例。数字立体定位细针活检钢丝放置精确率达83.3％,外科手术后标本摄片示病灶和钢丝已切除。半年后复查片中显示术前片病灶消失。46例定位患者术后未发生感染。结论：乳腺X线立体定位细针活检中正确和精细的操作是不可触及乳腺病灶准确定位、定性诊断的先决条件。     

超声TI-RADS分类与细针穿刺活检在诊断甲状腺恶性结节中的临床应用

目的探讨甲状腺影像报告和数据系统分类（TI-RADS）与细针穿刺活检（FNA）在诊断甲状腺恶性结节中的临床应用价值。 方法回顾性分析我院于2020年1月至2020年12月期间常规甲状腺超声检查中TI-RADS分类≥3类的585例患者的588个甲状腺结节,所有患者均接受甲状腺细针穿刺细胞学活检,其中266个甲状腺结节手术切除,以大体病理为金标准,评价超声TI-RADS分类与细针穿刺活检诊断甲状腺恶性结节的效能。 结果588个甲状腺结节细胞学病理诊断恶性243例、良性193例、性质不确定152例,超声TI-RADS 3、4、5类甲状腺恶性结节的阳性率分别为3.01%（4/133）、38.87%（110/283）、75.00%（129/172）;266个结节手术切除,大体病理诊断恶性211例、良性55例,细针穿刺活检诊断甲状腺恶性结节的敏感性、特异性、准确性分别为98.46%、93.02%、97.48%,阳性预测值为98.46%,阴性预测值为93.02%,阳性似然比为14.11,阴性似然比为0.017;穿刺感硬及有砂粒感诊断为甲状腺恶性结节的准确性明显高于穿刺感软及无砂粒感,差异有统计学意义（χ² = 70.206,65.083;P = 0.000,0.000）;超声TI-RADS分类及细针穿刺活检诊断甲状腺恶性结节的ROC曲线下面积分别为0.881及0.954。 结论超声TI-RADS分类结合细针穿刺活检对甲状腺恶性结节有较高的诊断价值,可更准确、更安全地判断甲状腺结节的良恶性,值得临床推广。     

Suspiciously malignant findings on ultrasound after fine needle aspiration biopsy in a thyroid nodule with initially benign ultrasound and cytologic result: to repeat or to follow-up

Purpose

The purposes of this study were to evaluate the incidence of suspiciously malignant change on ultrasound (US) in thyroid nodules after initial benign US and cytologic results and to investigate the associated US characteristics and the management of these nodules.

Materials and methods

Among the patients who underwent thyroid fine needle aspiration biopsy (FNAB) from October 2003 to December 2004, 550 patients who had thyroid nodules with initial benign US and cytologic results were included. Reference standards were established by pathologic results, follow-up cytologic results or follow-up US. We evaluated the incidence of morphologic changes to suspiciously malignant US findings of these thyroid nodules after FNAB. We also evaluated the initial US features associated with the nodules showing suspiciously malignant findings on US after FNAB in these patients.

Results

Of 550 patients, 28 nodules (5.1%) showed morphologic changes into nodules with suspiciously malignant US findings on follow-up US. All thyroid nodules showing morphologic changes had mixed solid and cystic components (P<.001). Suspiciously malignant changes on US were associated with the percentage of the cystic portion, but all changed nodules were confirmed as benign.

Conclusion

Follow-up US should be recommended rather than to repeat FNAB for thyroid nodules with initial benign US and cytologic results even if they later develop suspiciously malignant US features after FNAB.     

Punch biopsy or fine needle aspiration biopsy in percutaneous puncture

Purpose: The diagnostic accuracy and rate of complications of CT-guided core biopsies (CB) from suspected tumors of the chest were compared to the accuracy a complications of fine-needle aspiration biopsies (FNAB). Methods: The accuracy in the diagnosis of a benign or malignant lesion of 79 FNAB (19.5 G self-aspirating cutting needle) and of 83 CB (18 G automated core biopsy) and the rates of pneumothorax, pleural drainage and hemoptysis were retrospectively evaluated. Results: With FNAB, the sensitivity for malignant lesions was 62.1 % and the accuracy 68.4 %. With CB the sensitivity amounted to 85.9 % and accuracy to 86.7 %. The rate of pneumothorax was 25.3 % following FNAB, with a drainage rate of 5.1 % compared to 19.3 % and 6.0 %, respectively, following CB. The rate of pneumothorax and drainage increased with increasing path length through aerated lung. In advanced emphysema, the pneumothorax rate did not increase; however, in pneumothoraces, pleural drainage was mandatory in 20 % of FNAB and in 100 % of CB. Hemoptysis without any therapeutic consequences occurred in 3.8 % following FNAB and in 6.0 % following CB. Conclusions: With CB diagnostic accuracy can be clearly increased without an obvious increase in the complication rate. However, in patients with obvious emphysema, the pleural drainage rate of pneumothorax may be higher following CB.      

The role of ultrasound-guided fine needle aspiration biopsy in musculoskeletal diseases

Ultrasonography (US) is a readily available non-invasive tool useful for the detection of musculoskeletal and soft tissue masses. Although X-Ray is often the first imaging study for evaluating both bone and soft tissue lesions, and magnetic resonance imaging and computed tomography are mandatory in lesions staging, US is increasingly used for the early assessment of musculoskeletal and soft-tissue masses and for guiding procedures and biopsies. Surgical biopsy or fine needle aspiration biopsy (FNAB) is needed to ascertain the nature of any lesion. FNAB is a low cost technique, safer and less traumatic than an open surgical biopsy. Significant complications are rare, mostly related to the site of biopsy. Knowledge of indications, limitations, anatomical and pathological access, adequate technical expertise in US imaging and in intervention skills are the critical factors of the appropriate and safe use of FNAB. By now, the role of FNAB in musculoskeletal diseases is controversial and there is still a heated debate in the scientific community.     

Ultrasound-guided fine needle biopsy of the pancreas: smear cytology versus microhistology

Percutaneous fine needle biopsy (FNB), under sonographic guidance, of local pancreatic lesions was studied by comparing the results of smear cytology (SC) with microhistology (MH) in 34 patients in whom both sampling procedures were carried out. MH suffered from a higher number of inadequate samples (retrieval rate: 94.1% SC, 85.3% MH), but reached a superior sensitivity rate as regard to the diagnosis of pancreatic malignancy (91.7% MH, 80.8% SC). Both samples obtained an absolute specificity rate (100%. A 96.3% sensitivity rate was obtained by combination of the two techniques in the absence of complications. Thus, the combined use of SC and MH in pancreatic fine needle biopsy was proven to be a safe and reliable procedure.     

Fine needle biopsy without syringe aspiration

Aspiration biopsies of fresh disease-free bovine hepatic liver were performed with three commercially available, small-gauge biopsy needles. A syringe was used to create a negative pressure when using Chiba^® and Sure-cut^® needles. A syringe was not used when using PercuCut^TM needles which create an internal negative pressure equivalent to a 1.5 ml syringe when the stylet is partially withdrawn. The PercuCut and Chiba needle yielded a significantly larger specimen size than the Sure-Cut needle. There was no significant difference in sample size between the PercuCut and Chiba needles. All samples were of diagnostic quality.