Sparchez Zeno, Radu Pompilia, Kacso Gabriel, Eniu Dan, Hica Stefan, Sparchez Mihaela
Institute for Gastroenterology and Hepatology, 3rd Medical Department, Cluj-Napoca, Romania.
Med Ultrason. 2012 Dec;14(4):288-93.
In the diagnostic workup of superficial located tumors, percutaneous biopsy plays an important role. However, a successful retrieval of an adequate tissue sample is achievable in only 80-90% of the cases, mainly due to tissue inhomogenities. Contrast-enhanced ultrasound (CEUS) was successfully used to optimize the percutaneous biopsy in several tumors. The aim of our study was to assess the feasibility of CEUS as a direct guiding method for percutaneous biopsy of superficial toraco-abdominal and neck tumors.
Twenty patients aged 12-75 years with superficial toraco-abdominal and neck masses were studied. CEUS guided biopsy was performed using the contrast harmonic imaging technique with 9 MHz broadband linear transducer (10 cases) or 3.5MHz transducer (10 cases). The needle (18 G Bard coupled on an automatic device Bard Magnum) was directed in arterial phase into the enhanced, perfused areas. The following parameters were recorded: maximal length of the tumor, perfusion pattern, number of passages, length of the specimen, rate of complications.
The mean maximal length of the tumor was 6.95 cm (range 4-10.6 cm). CEUS guided biopsy was technical successful in 100% of patients. The mean number of passages needed to sample a good specimen was 1.6, range 1-3. The mean length of the specimen was 1.18 cm, range 0.8-1.4cm. The perfusion patterns of the tumors in our series were: P1-non-enhancing mass- 11.1 %, P2 peripherally enhancing mass with non-enhancing central area -5.6%, P3 diffusely enhancing mass with scattered non-enhancing areas -77.7 % and P4 completely homogeneously enhancing masses -5.6% of patients. The sensitivity of CEUS guided biopsy in the diagnosis of superficial tumors was 100%. For adenopathies a sub-typing was possible in all cases. There was only one minor hematoma around the punctured tumor in one patient.
In our series 83% of the tumors had a perfusion pattern (P2 and P3) that may lead to sampling errors in case of US guided biopsy. CEUS guided biopsy of toraco-abdominal and neck tumors is a feasible technique that improves the sensitivity of percutaneous biopsy to 100%.
在浅表肿瘤的诊断检查中，经皮活检起着重要作用。然而，由于组织不均匀性，仅80%-90%的病例能够成功获取足够的组织样本。对比增强超声（CEUS）已成功用于优化多种肿瘤的经皮活检。本研究的目的是评估CEUS作为浅表胸腹和颈部肿瘤经皮活检直接引导方法的可行性。
研究了20例年龄在12-75岁之间患有浅表胸腹和颈部肿块的患者。使用9MHz宽带线性换能器（10例）或3.5MHz换能器（10例）的对比谐波成像技术进行CEUS引导下的活检。将针（18G巴德针连接在自动装置巴德Magnum上）在动脉期指向增强、灌注的区域。记录以下参数：肿瘤最大长度、灌注模式、穿刺次数、标本长度、并发症发生率。
肿瘤平均最大长度为6.95cm（范围4-10.6cm）。CEUS引导下的活检在所有患者中技术成功率为100%。获取良好标本所需的平均穿刺次数为1.6次，范围为1-3次。标本平均长度为1.18cm，范围为0.8-1.4cm。我们系列中肿瘤的灌注模式为：P1-无强化肿块-11.1%，P2-周边强化肿块伴中央无强化区域-5.6%，P3-弥漫性强化肿块伴散在无强化区域-77.7%，P4-完全均匀强化肿块-5.6%的患者。CEUS引导下活检对浅表肿瘤诊断的敏感性为100%。对于淋巴结病，所有病例均能进行亚型分类。仅1例患者在穿刺肿瘤周围出现轻微血肿。
在我们的系列中，83%的肿瘤具有（P2和P3）灌注模式，在超声引导活检时可能导致采样误差。CEUS引导下的胸腹和颈部肿瘤活检是一种可行的技术，可将经皮活检的敏感性提高到100%。
