Goldstein Mark A, Atri Mostafa, O'Malley Martin, Jacks Lindsay, John Rohan, Herzenberg Andrew, Reich Heather, Ghai Sangeet
John Radcliffe Hospital, Department of Radiology, Headley Way, Oxford, UK.
J Comput Assist Tomogr. 2013 Mar-Apr;37(2):176-82. doi: 10.1097/RCT.0b013e31827bf6a0.
The purpose of this study was to evaluate factors affecting the success of ultrasound-guided core biopsy of kidneys and determine the optimum number of passes.
This retrospective study evaluated 484 nonfocal renal biopsies performed with 18-gauge side-notch biopsy needles. Number of biopsy passes, serum creatinine, body mass index, needle type, transplant age, kidney size, diabetic status, and operator were evaluated as predictors of the number of biopsy passes.
Four hundred seventy-four biopsies (338 transplant, 136 native) were included with mean number of passes 2.87 (3.1 native vs 2.78 transplant; P = 0.002). Mean number of glomeruli yielded per pass was 6.9 (7.2 transplant vs 6.1 native; P = 0.0002) with 3 passes adequate for histological diagnosis in 84% of biopsies. Native kidney, increasing serum creatinine level, trainee biopsy operator, and use of a Temno needle were found to be independent predictors of having more than 3 biopsy passes on multivariate analysis. Age, sex, body mass index, diabetic status, and kidney size were not associated with the number of biopsy passes.
The success of a nonfocal renal biopsy has many influencing variables, and in the absence of an on-site electron microscopy technologist to immediately evaluate biopsy samples, 3 passes with an 18-gauge needle would be adequate in 84% of kidneys to achieve a histological diagnosis, with 2 passes needed for transplant kidneys to meet the Banff 97 criteria.
本研究旨在评估影响超声引导下肾穿刺活检成功率的因素，并确定最佳穿刺次数。
本回顾性研究评估了484例使用18号侧切口活检针进行的非局灶性肾活检。将活检穿刺次数、血清肌酐、体重指数、针型、移植年龄、肾脏大小、糖尿病状态和操作者作为活检穿刺次数的预测因素进行评估。
纳入474例活检（338例移植肾，136例自体肾），平均穿刺次数为2.87次（自体肾为3.1次，移植肾为2.78次；P = 0.002）。每次穿刺获得的肾小球平均数量为6.9个（移植肾为7.2个，自体肾为6.1个；P = 0.0002），84%的活检3次穿刺足以进行组织学诊断。多因素分析显示，自体肾、血清肌酐水平升高、实习活检操作者以及使用Temno针是穿刺次数超过3次的独立预测因素。年龄、性别、体重指数、糖尿病状态和肾脏大小与穿刺次数无关。
非局灶性肾活检的成功率受多种变量影响，在没有现场电子显微镜技术人员立即评估活检样本的情况下，84%的肾脏使用18号针穿刺3次足以进行组织学诊断，移植肾穿刺2次可满足班夫97标准。
