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经皮穿刺活检在肾肿块诊断中的作用是什么?

What is the role of percutaneous needle core biopsy in diagnosis of renal masses?

机构信息

Department of Urology, Erciyes University, Kayseri, Turkey.

出版信息

Urology. 2010 Sep;76(3):614-8. doi: 10.1016/j.urology.2009.09.089. Epub 2010 Jan 29.

Abstract

OBJECTIVE

To define the accuracy and acceptability of ultrasonography-guided percutaneous needle core biopsy in diagnosis of renal masses.

METHODS

The data of 42 consecutive patients on whom needle biopsies were performed and were surgically treated for suspicious renal masses in our clinic between January 2001 and April 2008 were evaluated. In all patients, needle biopsies were done percutaneously with an 18-gauge needle under local anesthesia in prone position with ultrasonography guidance. Two cores were taken from each tumor. The pathology results of biopsy and surgical specimens were compared.

RESULTS

The mean age was 56.1 years (range, 21-77 years). The mean follow-up period was calculated as 44.8 months (range, 10-85 months). The abdominal computed tomography imaging showed that the mean mass size was 63.9 mm (range, 25-140 mm). Of 42 patients, 39 were diagnosed (92.8%) after the first biopsy. The accuracy of percutaneous needle biopsy in differentiating between malignant and benign masses was calculated as 90% (36/40).The accuracy of histopathological diagnostic typing as against the postsurgical pathologic examination results was 77.5% (31/40) and the accuracy in the Fuhrman grade was 51.5% (17/33). The sensitivity was calculated as 91.4% and specificity as 60%. Its negative predictive value was 50% and positive predictive value was 94.1%.

CONCLUSIONS

In conclusion, percutaneous renal needle core biopsy has an acceptable sensitivity and specificity in the diagnosis of renal masses. The major limitation of percutaneous core biopsy is the technical failure that leads to insufficient material for accurate diagnosis.

摘要

目的

明确超声引导经皮穿刺肾活检在诊断肾脏肿块中的准确性和可接受性。

方法

回顾性分析 2001 年 1 月至 2008 年 4 月我院 42 例行超声引导下经皮穿刺活检术并经手术治疗的可疑肾脏肿块患者的临床资料。所有患者均在局麻下于俯卧位行超声引导下经皮 18G 穿刺活检,每个肿瘤取 2 个核心标本。比较活检和手术标本的病理结果。

结果

患者平均年龄为 56.1 岁(2177 岁)。平均随访时间为 44.8 个月(1085 个月)。腹部 CT 显示肿块平均大小为 63.9mm(25~140mm)。42 例患者中,39 例(92.8%)首次活检后得到确诊。经皮穿刺活检术鉴别良恶性肿块的准确率为 90%(36/40)。与术后病理检查结果相比,组织病理学诊断分型的准确率为 77.5%(31/40),Fuhrman 分级的准确率为 51.5%(17/33)。敏感度为 91.4%,特异度为 60%。其阴性预测值为 50%,阳性预测值为 94.1%。

结论

经皮肾穿刺活检术在诊断肾脏肿块方面具有可接受的敏感度和特异度。经皮穿刺活检的主要局限性在于技术失败导致无法获得准确诊断的足够材料。

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