Department of Radiology, Section of Musculoskeletal Imaging, David Geffen School of Medicine, University of California, Los Angeles, 200 Medical Plaza, Suite 165-59, Los Angeles, CA 90095, USA.
J Vasc Interv Radiol. 2012 Apr;23(4):511-18, 518.e1-2. doi: 10.1016/j.jvir.2012.01.058. Epub 2012 Mar 3.
To retrospectively assess percutaneous core needle biopsies performed by radiologists and the association with tumor seeding along the biopsy tract when anatomic compartment guidelines are not consistently observed.
Retrospective data from computerized patient records and digital images from 363 consecutive computed tomography-guided biopsies of the lower extremity (thigh and leg) performed by radiologists at a single institution from August 2002 to August 2008 were analyzed for breaches of biopsy guidelines.
Of the 363 biopsies, 243 (67%) were of soft tissue lesions and 120 (33%) were of bony lesions. There were 188 (52%) malignant and 175 (48%) benign lesions. The following biopsy breaches were observed: 13 (3.6%) of anatomic compartment, 42 (11.6%) of "vital structures," and 82 (68.3%) of needle path for bony tumors. Vital structures as defined by the literature included, but were not limited to, the following: knee joint capsule, greater trochanteric bursa, rectus femoris and vastus intermedius muscles, tibial tubercle, peroneus brevis and peroneus longus distal tendons, and neurovascular bundles. No cases of tumor recurrences could be attributed to needle seeding along a biopsy tract for any of these biopsy guideline breaches.
The concern for needle tract seeding with musculoskeletal tumors is more widespread than the evidence supporting it as a significant or frequent complication. In this study, breaching anatomic compartment, vital structures (other than neurovascular structures), and suggested exact needle path guidelines were not associated with needle tract seeding in the lower extremity.
回顾性评估放射科医生进行的经皮核心针活检，并在未始终遵循解剖分区指南时评估肿瘤在活检通道中的播种情况。
对 2002 年 8 月至 2008 年 8 月期间，在一家机构中，由放射科医生对 363 例连续进行的下肢（大腿和小腿）计算机断层扫描引导下活检的计算机患者记录和数字图像进行回顾性数据分析，以评估活检指南的突破情况。
363 例活检中，243 例（67%）为软组织病变，120 例（33%）为骨病变。其中恶性病变 188 例（52%），良性病变 175 例（48%）。观察到以下活检突破：13 例（3.6%）解剖分区，42 例（11.6%）“重要结构”，82 例（68.3%）骨肿瘤的针道。文献中定义的重要结构包括但不限于以下内容：膝关节囊、大转子滑囊、股直肌和股中间肌、胫骨结节、腓骨短肌和腓骨长肌远端肌腱以及神经血管束。在这些活检指南突破中，没有任何肿瘤复发的病例可归因于沿活检通道播种。
与支持其作为重要或常见并发症的证据相比，人们对肌肉骨骼肿瘤沿活检通道播种的担忧更为广泛。在这项研究中，突破解剖分区、重要结构（除神经血管结构外）和建议的精确针道指南与下肢的针道播种无关。
