Oncogynecologic Center, Department of Obstetrics and Gynecology and, First Medical Faculty and General Teaching Hospital, Charles University, Prague, Czech Republic.
Ultrasound Obstet Gynecol. 2010 Dec;36(6):767-72. doi: 10.1002/uog.8803.
To analyze the safety, adequacy and accuracy of tru-cut biopsy and to evaluate factors potentially affecting adequacy.
We analyzed retrospectively a group of patients who had undergone tru-cut biopsy for either primary suboptimally operable tumors, recurrence or suspected non-genital or secondary tumor. Tru-cut biopsy was performed either transvaginally or transabdominally, using an automatic biopsy gun with disposable needle and needle guide attached to the probe. The adequacy, i.e. obtaining a sample sufficient for identification of the origin of the tumor and performance of immunohistochemistry; accuracy, i.e. agreement between biopsy and final postoperative histology; and safety, as determined by complication rate, were assessed. Variables potentially influencing adequacy were analyzed using the orthogonal projections to latent structure method.
A total of 195 biopsies were performed on 190 patients. An adequate sample was obtained in 178 (91.3%) biopsies. The final histology was not in agreement with the result from tru-cut biopsy in two out of 118 patients who underwent subsequent surgery (accuracy 98.3%). There were complications in two cases out of the 195 biopsies performed (1.0%). Ascites, elevated CA 125, primary suboptimal operable tumor, serous epithelial ovarian cancer histology, carcinomatosis and vaginal approach were significant positive predictors for the achievement of an adequate sample, while recurrence as an indication, non-serous and non-ovarian histotypes and transabdominal approach were negative predictors.
Ultrasound-guided tru-cut biopsy is an efficient, minimally invasive, accurate and safe diagnostic method in the management of advanced, recurrent or atypical abdominal and pelvic tumors of probable non-genital origin, where unnecessary laparotomy or laparoscopy can be avoided. The adequacy of tru-cut biopsy is mainly influenced by indication group, histology, site of biopsy and approach. Our analysis can help in counseling the patient before the procedure and helps to explain the possible causes of failure of the procedure.
分析 tru-cut 活检的安全性、充分性和准确性，并评估可能影响充分性的因素。
我们回顾性分析了一组因原发性手术不充分的可切除肿瘤、复发或疑似非生殖系统或继发性肿瘤而行 tru-cut 活检的患者。tru-cut 活检经阴道或经腹部进行，使用带有一次性针和针引导器的自动活检枪，将探头连接到针上。通过并发症发生率评估充分性（即获得足以识别肿瘤来源和进行免疫组织化学的样本）、准确性（即活检与最终术后组织学的一致性）和安全性。使用正交投影到潜在结构方法分析潜在影响充分性的变量。
对 190 例患者的 195 次活检进行了分析。178 次活检（91.3%）获得了充分的样本。在随后接受手术的 118 例患者中，有 2 例最终组织学与 tru-cut 活检结果不一致（准确率为 98.3%）。在进行的 195 次活检中有 2 例出现并发症（1.0%）。腹水、CA125 升高、原发性手术不充分的肿瘤、浆液性上皮性卵巢癌组织学、转移和阴道入路是获得充分样本的显著正预测因素，而作为指征的复发、非浆液性和非卵巢组织学类型以及经腹入路是负预测因素。
超声引导 tru-cut 活检是一种高效、微创、准确、安全的诊断方法，适用于管理可能为非生殖系统来源的晚期、复发性或非典型性腹部和盆腔肿瘤，可避免不必要的剖腹手术或腹腔镜检查。tru-cut 活检的充分性主要受指征组、组织学、活检部位和方法的影响。我们的分析可以帮助患者在术前进行咨询，并有助于解释该手术失败的可能原因。
