Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
Cancer. 2011 Sep 1;117(17):4041-8. doi: 10.1002/cncr.25980. Epub 2011 Mar 8.
The diagnostic yield was evaluated of percutaneous image-guided tissue biopsy of hepatic lesions identified on computed tomography performed for staging of a primary malignancy, and it was determined how often the biopsy result was unexpectedly negative, benign, or secondary to a second unknown malignancy.
In a retrospective investigation from 1998 through 2008, 580 patients with primary malignancies had indeterminate focal hepatic lesions and underwent percutaneous image-guided biopsy; 369 patients had lesions in their liver at first cross-sectional imaging, performed for staging; 211 patients had a negative liver imaging study, followed by the subsequent appearance of at least 1 indeterminate suspicious lesion. The results of percutaneous image-guided tissue biopsies were compared with the histology of the primary malignancy.
Liver biopsies were performed in 580 patients (288 men and 292 women; age, 25-92 years; mean age, 61 years). The most common primary malignancies were pancreatic (n = 96), breast (n = 85), melanoma (n = 57), esophageal (n = 51), lung (n = 47), colorectal (n = 37), and urothelial tumors (n = 26). Biopsy results were positive for malignancy in 528 (91%) cases. Among the positive biopsies, 29 (5%) cases had pathology results different from the primary tumor. Of the 52 biopsies negative for malignancy, 20 yielded a specific benign diagnosis, and 32 were nondiagnostic.
If all liver lesions had been assumed to be metastases, as expected secondary to the known primary tumor, then the true or presumed alternate diagnosis would have been missed in 60 (10.3%) of the 580 cases. The authors did not attempt to determine whether actual clinical management changed based on these 60 liver biopsy results, so this number is an upper bound on management change. On the basis of these results, and given the minimal complication rate of liver biopsy, the authors suggest that liver biopsy should still be performed in the types of cases studied here, despite the finding that the vast majority of biopsies produced the expected result and presumably did not change patient management.
评估了经皮 CT 引导下肝占位病变活检对原发性恶性肿瘤分期的诊断效能，并确定活检结果意外为阴性、良性或继发于第二种未知恶性肿瘤的频率。
在 1998 年至 2008 年的回顾性研究中，580 例原发性恶性肿瘤患者的肝内局灶性病变行经皮 CT 引导下活检，其中 369 例患者在首次进行分期的横断面成像中发现肝内病变，211 例患者肝脏影像学检查阴性，随后出现至少 1 个不确定的可疑病变。将经皮 CT 引导下组织活检的结果与原发性恶性肿瘤的组织学进行比较。
580 例患者（288 例男性，292 例女性；年龄 25-92 岁；平均年龄 61 岁）进行了肝活检。最常见的原发性恶性肿瘤为胰腺癌（96 例）、乳腺癌（85 例）、黑色素瘤（57 例）、食管癌（51 例）、肺癌（47 例）、结直肠癌（37 例）和尿路上皮肿瘤（26 例）。528 例（91%）活检结果为恶性。在阳性活检中，29 例（5%）的病理学结果与原发性肿瘤不同。52 例阴性活检中，20 例活检有明确的良性诊断，32 例为非诊断性结果。
如果所有肝内病变均被认为是转移灶，如预期的继发于已知的原发性肿瘤，则在 580 例病例中，有 60 例（10.3%）会遗漏真正或假定的其他诊断。作者并未尝试确定这些 60 例肝活检结果是否改变了实际的临床管理，因此这个数字是管理改变的上限。基于这些结果，并考虑到肝活检的并发症发生率很低，作者建议在本研究的病例类型中，仍应进行肝活检，尽管大多数活检结果均符合预期，且推测不会改变患者的管理。
