Chew C, Reid R, O'Dwyer P J
University Department of Surgery, Western Infirmary, Glasgow G11 6NT, UK.
Surgeon. 2006 Apr;4(2):79-81. doi: 10.1016/s1479-666x(06)80034-x.
A retroperitoneal mass arising outside a specific organ usually gives rise to diagnostic uncertainty. Because of this, many clinicians request a radiologically guided biopsy. The aim of this study was to compare clinical and radiologic assessment with and without biopsy in patients undergoing surgical resection of a large abdominal mass.
All patients undergoing resection of a large retroperitoneal mass under the care of one surgeon between 1994 and 2004 were included in this study.
One hundred and twenty-one patients underwent resection of a large retriperitoneal mass, of whom 84 had primary disease (median size 20cm, range 7cm-40cm). Thirty-six had clinical and radiologic assessment with biopsy while 48 had no biopsy. In the biopsy group four patients had a false negative result while two had a false positive result for a malignant tumour. Three patients had incorrect malignant histology on biopsy which led to an error in management in two. In addition, two adverse events related to biopsy were observed. One patient in the no biopsy group had an error in management. Sensitivity for diagnosis of a soft tissue tumour was 80.8% (95% CI 69.5%-92.1%) for clinical and radiologic assessment alone versus 91.6% (95% CI 82.6%-100%) when biopsy was added.
Biopsy adds no value to clinical and radiologic assessment of the patient with a resectable large retroperitoneal mass.
起源于特定器官之外的腹膜后肿块通常会导致诊断上的不确定性。因此，许多临床医生会要求进行放射学引导下的活检。本研究的目的是比较在接受腹部大肿块手术切除的患者中，进行活检与不进行活检时的临床和放射学评估情况。
纳入1994年至2004年间在一名外科医生治疗下接受大腹膜后肿块切除术的所有患者。
121例患者接受了大腹膜后肿块切除术，其中84例为原发性疾病（中位大小20cm，范围7cm - 40cm）。36例进行了临床和放射学评估并活检，48例未进行活检。在活检组中，4例患者出现假阴性结果，2例出现恶性肿瘤假阳性结果。3例患者活检时恶性组织学诊断错误，导致2例治疗失误。此外，观察到2例与活检相关的不良事件。未活检组中有1例患者治疗失误。单独进行临床和放射学评估时，软组织肿瘤诊断的敏感性为80.8%（95%可信区间69.5% - 92.1%），而增加活检后为91.6%（95%可信区间82.6% - 100%）。
对于可切除的大腹膜后肿块患者，活检对临床和放射学评估没有价值。
