Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA.
J Vasc Interv Radiol. 2010 Oct;21(10):1539-47; quiz 1547. doi: 10.1016/j.jvir.2010.05.025.
Imaging techniques can detect small liver lesions, although these are a challenge to biopsy, particularly in cirrhotic liver. The authors assessed the diagnostic success of image-guided biopsies collected from small (≤ 3 cm) focal liver lesions.
This single-center, retrospective study included 374 patients (199 men; mean age, 62 ± 15). Eighteen-gauge core biopsy and 22-gauge fine needle aspiration (FNA) samples were collected from small focal liver lesions. Samples were compared by histology versus cytology, malignant versus benign, from lesions smaller versus larger than 1.5 cm, from livers with versus without cirrhosis, collected by computed tomography (CT) guidance versus ultrasound, and from different locations in the liver.
The combined accuracy of core biopsy plus FNA analysis was 95.5%; core biopsy alone characterized 93.3% of samples, and FNA alone characterized 72.5% (P < .001). Biopsy successfully characterized 94.5% of malignant lesions and 98.8% of benign lesions (P > .05). Biopsy characterized 95.3% (102 of 107) lesions ≤ 1.5 cm. The success in cirrhotic livers was 94.8%, for CT-guided biopsies was 95%, and for ultrasound-guided biopsies was 95.8% (P > .05). The success rate was lower in liver caudate lobe than in other locations (P < .05).
Image-guided biopsy of small (≤ 3 cm) focal liver lesions is highly reliable with the use of core biopsy alone. Neither size ≤ 1.5 cm nor presence of cirrhosis is an impediment to biopsy. CT and ultrasound guidance produce similar rates of success.
影像学技术可检测到小的肝病变，尽管这些病变在肝硬化肝脏中进行活检具有挑战性。作者评估了从小（≤3cm）局灶性肝病变采集的影像引导活检的诊断成功率。
这是一项单中心、回顾性研究，共纳入 374 例患者（199 例男性；平均年龄 62±15 岁）。从小的局灶性肝病变采集 18 号活检针芯和 22 号细针抽吸（FNA）样本。通过组织学与细胞学、恶性与良性、病变大小＜1.5cm 与＞1.5cm、有肝硬化与无肝硬化、CT 引导与超声引导、肝脏不同部位进行比较。
芯针活检加 FNA 分析的综合准确率为 95.5%；单独芯针活检可描述 93.3%的样本，单独 FNA 可描述 72.5%（P＜0.001）。活检成功描述了 94.5%的恶性病变和 98.8%的良性病变（P＞0.05）。活检可成功描述 95.3%（102/107）直径≤1.5cm 的病变。在肝硬化肝脏中，成功率为 94.8%，CT 引导活检为 95%，超声引导活检为 95.8%（P＞0.05）。肝尾状叶的成功率低于其他部位（P＜0.05）。
单独使用芯针活检可高度可靠地对小（≤3cm）局灶性肝病变进行活检。病变直径≤1.5cm 或存在肝硬化均不是活检的障碍。CT 和超声引导产生相似的成功率。
