Tru-cut活检作为伴有软组织侵犯的骨肿瘤组织诊断的初始方法。
Tru-cut biopsy as the initial method of tissue diagnosis in bone tumors with soft tissue extension.
作者信息
Joshi Amit, Magar Sushil Rana, Chand Pankaj, Panth Rajesh, Khatri Chhetri Bachchu Ram
机构信息
Department of Orthopedics, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal.
出版信息
Indian J Orthop. 2013 Mar;47(2):195-9. doi: 10.4103/0019-5413.108917.
BACKGROUND
Tru-cut biopsy in suspected bone tumors can be performed even in less specialized centers. Tru-cut biopsy has been proved as safe with more than 90% accuracy. However, its usefulness was not widely studied in general hospitals where Tru-cut biopsy is performed by orthopedic surgeons. This study was conducted to find out the accuracy and adequacy of Tru-cut biopsy performed by an orthopedic surgeon not trained in musculoskeletal oncology, in a general hospital.
MATERIALS AND METHODS
A study was conducted through a prospectively collected database using a uniform protocol. All patients who had a malignant appearing bone lesion with a palpable soft tissue mass were included in the current study. Fifty such consecutive cases underwent Tru-Cut biopsy by orthopedic residents or registrars who were aware of the principles of Tru-cut biopsy and the recommendations of Musculoskeletal Tumor Society. When an open biopsy or a resection of the tumor was subsequently performed, the histological diagnosis was compared for accuracy with the diagnosis of needle biopsy. We evaluated adequacy of sample obtained and accuracy of diagnosis in terms of sensitivity, specificity, positive predictive value, and negative predictive value.
RESULTS
Seventy seven cases were initially enrolled. Out of which 18 were excluded and 59 patients were biopsied. Out of which 50 were analysed. Only 4 out of 50 biopsied specimens were inadequate resulting in an adequacy rate of 92%. Among 46 cases, which were analyzed for diagnostic accuracy, 84.78% had true-positive result, 8.69% had true negative, and 6.52% had false-negative report. The sensitivity and specificity of Tru-cut biopsy in our series was 92.85% and 100%, respectively, with positive predictive value of 100% and negative predictive value of 57.14%.
CONCLUSIONS
Tru-cut biopsy can be recommended as an initial method of tissue diagnosis in musculoskeletal tumors with soft tissue extension.
背景
在疑似骨肿瘤的情况下，即使在不太专业的中心也可以进行粗针穿刺活检。粗针穿刺活检已被证明是安全的，准确率超过90%。然而，在由骨科医生进行粗针穿刺活检的综合医院中，其效用尚未得到广泛研究。本研究旨在了解在综合医院中，由未接受过肌肉骨骼肿瘤学培训的骨科医生进行粗针穿刺活检的准确性和充分性。
材料与方法
通过使用统一方案的前瞻性收集数据库进行研究。本研究纳入了所有出现恶性骨病变且伴有可触及软组织肿块的患者。五十例此类连续病例由了解粗针穿刺活检原则和肌肉骨骼肿瘤学会建议的骨科住院医师或住院医生进行粗针穿刺活检。随后进行开放性活检或肿瘤切除时，将组织学诊断与针吸活检诊断的准确性进行比较。我们从敏感性、特异性、阳性预测值和阴性预测值方面评估了所获取样本的充分性和诊断的准确性。
结果
最初纳入77例。其中18例被排除，59例患者接受了活检。其中50例进行了分析。50例活检标本中只有4例不充分，充分率为92%。在分析诊断准确性的46例病例中，84.78%为真阳性结果，8.69%为真阴性，6.52%为假阴性报告。我们系列研究中粗针穿刺活检的敏感性和特异性分别为92.85%和100%，阳性预测值为100%，阴性预测值为57.14%。
结论
对于有软组织延伸的肌肉骨骼肿瘤，粗针穿刺活检可作为组织诊断的初始方法推荐使用。
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