Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul, 135-710, Korea.
Int Orthop. 2009 Dec;33(6):1701-6. doi: 10.1007/s00264-009-0835-9. Epub 2009 Aug 5.
The purpose of this study was to assess the diagnostic value of imaging-guided core needle biopsy for the diagnosis of musculoskeletal lesions. Between 2004 and 2007, 309 biopsies (ultrasound 151, computed tomography 89, and fluoroscopy 69) were included. There were 142 soft tissue and 167 bony lesions. Diagnostic yields and accuracies were assessed using the chi-square test or Fisher's exact test with Bonferroni's correction when necessary. Overall diagnostic yield was 90.6% for all 309 lesions (bone 91.6% vs. soft tissue 89.3%, p = 0.5125). The diagnostic accuracy of the 185 core needle biopsies, which were confirmed by definitive surgical biopsies, was 84.3% (bone 88.9% vs. soft tissue 79.1%, p = 0.0669). The yields of homogenous bone tumours (96.8%) were not significantly higher than those of bone tumours with a heterogenic architecture (86.4%, p = 0.0794). The difference between accuracies for homogenous bone tumours (89.1%) and heterogenous bone tumours (85.0%) was not significant (p = 0.6930). However, for soft tissue tumours, homogenous tumours had a significantly higher diagnostic yield than heterogenous tumours (97.5% vs. 81.4%, p = 0.0036). Diagnostic accuracy for homogenous tumours was also significantly higher than that for heterogenous soft tissue tumours (94.4% vs. 60.6%, p < 0.0001). The image-guided percutaneous needle biopsy of musculoskeletal lesions is a safe and effective procedure if it is performed selectively in soft tissue tumours with homogenous architectures.
本研究旨在评估影像学引导下的核心针活检对肌肉骨骼病变的诊断价值。2004 年至 2007 年间，共纳入 309 例活检（超声 151 例，计算机断层扫描 89 例，透视 69 例），其中软组织病变 142 例，骨病变 167 例。使用卡方检验或 Fisher 确切检验（必要时使用 Bonferroni 校正）评估诊断率和准确率。309 例病变的总诊断率为 90.6%（骨 91.6%比软组织 89.3%，p=0.5125）。经明确的手术活检证实的 185 例核心针活检的诊断准确率为 84.3%（骨 88.9%比软组织 79.1%，p=0.0669）。同质骨肿瘤（96.8%）的诊断率并不显著高于异质骨肿瘤（86.4%，p=0.0794）。同质骨肿瘤（89.1%）和异质骨肿瘤（85.0%）的准确率差异无统计学意义（p=0.6930）。然而，对于软组织肿瘤，同质肿瘤的诊断率明显高于异质肿瘤（97.5%比 81.4%，p=0.0036）。同质肿瘤的诊断准确率也明显高于异质软组织肿瘤（94.4%比 60.6%，p<0.0001）。如果在具有同质结构的软组织肿瘤中进行有选择性的影像学引导经皮针活检，这是一种安全有效的方法。
