Sofocleous Constantinos T, Schubert Johanna, Brown Karen T, Brody Lynn A, Covey Anne M, Getrajdman George I
Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA.
J Vasc Interv Radiol. 2004 Oct;15(10):1099-104. doi: 10.1097/01.RVI.0000130815.79121.EC.
To evaluate the safety and efficacy of direct computed tomography (CT)-guided fine needle aspiration biopsy (FNAB) of pancreatic and peripancreatic masses via a posterior approach that traverses the inferior vena cava (IVC) or renal vein.
From January 2000 to July 2003, 55 patients underwent 58 biopsies of masses located within the pancreas (n = 28) or in a peripancreatic location (n = 30) with use of a posterior approach that crossed the IVC or renal vein. Biopsies were performed with needles ranging in size from 18 to 22. Cytology reports and medical records of all patients were retrospectively reviewed to evaluate diagnostic accuracy and complication rates.
Masses were safely accessed with a direct (noncoaxial) pathway traversing the IVC (n = 54), renal vein (n = 4), or both (n = 3). Overall diagnostic accuracy was 86% (50 of 58). Cytologic examination was positive for malignancy in 39 of 58 biopsies (67%). Benign lesions were demonstrated in 12 of 58 biopsies. In seven cases (12%), the sample was deemed nondiagnostic. Of those, four were diagnosed later by endoscopy (n = 1), surgical biopsy (n = 2), or repeat FNAB (n = 1). A false-negative result was noted in one case, which was later diagnosed by repeat biopsy. A total of four inadvertent passes through the right renal artery were recorded. CT evidence of perilesional blood was seen in eight of 55 patients (eight of 58 cases). Three of these occurred after a passage via the right renal artery. All patients remained asymptomatic, and no transfusion or change in management was necessary. No other complications occurred.
CT-guided noncoaxial FNAB with an approach that traverses the IVC or renal vein is safe and effective in obtaining diagnostic specimens from pancreatic and peripancreatic masses.
评估经后入路穿过下腔静脉（IVC）或肾静脉的直接计算机断层扫描（CT）引导下胰腺及胰腺周围肿块细针穿刺活检（FNAB）的安全性和有效性。
2000年1月至2003年7月，55例患者接受了58次活检，这些肿块位于胰腺内（n = 28）或胰腺周围（n = 30），采用穿过IVC或肾静脉的后入路。活检使用的针大小从18号到22号不等。对所有患者的细胞学报告和病历进行回顾性分析，以评估诊断准确性和并发症发生率。
通过直接（非同轴）路径安全地穿刺到肿块，该路径穿过IVC（n = 54）、肾静脉（n = 4）或两者（n = 3）。总体诊断准确性为86%（58例中的50例）。58次活检中有39次（67%）细胞学检查恶性呈阳性。58次活检中有12次显示为良性病变。7例（12%）样本被认为无法诊断。其中，4例后来通过内镜检查（n = 1）、手术活检（n = 2）或重复FNAB（n = 1）得以诊断。1例出现假阴性结果，后来通过重复活检得以诊断。总共记录到4次意外穿过右肾动脉的情况。55例患者中有8例（58例中的8例）在CT上可见病灶周围有血液。其中3例发生在穿过右肾动脉之后。所有患者均无症状，无需输血或改变治疗方案。未发生其他并发症。
CT引导下采用穿过IVC或肾静脉的非同轴FNAB方法，对于从胰腺及胰腺周围肿块获取诊断性标本是安全有效的。
