Department of Radiology, A.Y. Ankara Oncology Education and Research Hospital, 06200 Ankara, Turkey.
Panminerva Med. 2012 Sep;54(3):233-9.
The aim of this study was to compare small size aspiration needles with large size cutting needles in focal liver lesions for using small needles instead of large ones without on-site cytopathologist.
Percutaneous ultrasonography-guided liver biopsy was evaluated retrospectively in a biopsy cohort study of 1300 patients. In this series, 690 patients were biopsied with large size (<19G) cutting needles and 610 with small size (20G) aspiration needles. On-site cytopathologist was not present in the biopsy-room at any intervention. Needles were compared for diagnostic accuracy and safety for various focal liver diseases.
We had diagnostic accuracy rate of 85.0% in small needle group vs. 96.9% in large needle group with metastasis (P<0.001). This rate was 85.5% in small needle group vs. 97.9% in large needle group with hepatocellular carcinoma (P=0.039). Accuracy rates of them were not different in hemangioma (P=0.277) and infection-inflammation (P=0.470). This rate was 75.0% in small needle group vs. 98.9% in large needle group with regenerative nodules (P=0.018). These rates were not different in focal steatosis (P=1.000). Sensitivity, specificity, and accuracy were 85.1%, 100%, and 89.2%, respectively. Only 2 (0.15%) major complications were found with small needles in uncooperative patients. Any major complication was not seen in hemangioma.
In uncertain diagnosis with modern imaging, we propose that large size cutting needles should be used in suspected liver metastasis, hepatocellular carcinoma, and regenerative nodules if cytopathologist was not present. Small needles can be successfully used as well as large ones in focal steatosis, infection-inflammation, and hemangioma of liver in unclear diagnosis.
本研究旨在比较小尺寸抽吸针与大尺寸切割针在局灶性肝脏病变中的应用，以期在无现场细胞病理学家的情况下，用小针代替大针。
对 1300 例经皮超声引导下肝活检患者进行回顾性活检队列研究。在该系列中，690 例患者使用大尺寸（<19G）切割针进行活检，610 例患者使用小尺寸（20G）抽吸针进行活检。在任何介入操作中，活检室都没有现场细胞病理学家。比较了各种局灶性肝脏疾病的诊断准确性和安全性。
我们在小针组的诊断准确率为 85.0%，而大针组的转移瘤诊断准确率为 96.9%（P<0.001）。在小针组，肝细胞癌的诊断准确率为 85.5%，而大针组为 97.9%（P=0.039）。在肝血管瘤（P=0.277）和感染-炎症（P=0.470）中，两组的准确率无差异。在再生结节中，小针组的诊断准确率为 75.0%，大针组为 98.9%（P=0.018）。在局灶性脂肪变性中，两组的诊断准确率无差异（P=1.000）。小针组的敏感性、特异性和准确性分别为 85.1%、100%和 89.2%。仅在不合作患者中发现 2 例（0.15%）严重并发症。在肝血管瘤中未发现任何严重并发症。
在现代影像学不确定诊断的情况下，如果没有细胞病理学家，我们建议在怀疑肝转移、肝细胞癌和再生结节时使用大尺寸切割针。在诊断不明确的局灶性脂肪变性、感染-炎症和肝血管瘤中，小针也可以像大针一样成功使用。
