Kiatisevi Piya, Thanakit Voranuch, Sukunthanak Bhasanan, Boonthatip Mayura, Bumrungchart Saraporn, Witoonchart Kiat
Orthopaedic Oncology Unit, Institute of Orthopaedics, Lerdsin General Hospital, Bangkok, Thailand.
J Orthop Surg (Hong Kong). 2013 Aug;21(2):204-8. doi: 10.1177/230949901302100218.
PURPOSE. To compare computed tomography (CT)- guided core needle biopsy (CNB) with incisional biopsy in diagnosing musculoskeletal lesions. METHODS. 62 men and 50 women aged 12 to 83 (mean, 45) years who underwent a CT-guided CNB were compared with 31 men and 33 women aged 9 to 81 (mean, 53) years who underwent an incisional biopsy. All specimens had final pathology report to compare with. Comparisons were made in terms of (1) diagnostic rate, (2) accuracy in distinguishing benign from malignant lesions, (3) accuracy in distinguishing low- from high-grade sarcomas, (4) accuracy for histological diagnosis, and (5) complication and repeated biopsy rates. RESULTS. The diagnostic rate of CT-guided CNB and incisional biopsy was not significantly different (92.9% vs. 96.9%, p=0.33), nor were the accuracy in distinguishing benign from malignant lesions (100% vs. 98.4%, p=0.37), the accuracy in distinguishing low- from high-grade sarcomas (100% vs. 100%, p=1.00), the accuracy for specific diagnosis (75.9% vs. 85.2%, p=0.17), the repeated biopsy rate (6.3% vs. 4.7%, p=0.75), and the complication rate (0.9% vs. 4.7%, p=0.14). The accuracy for specific diagnosis was higher for bone than soft-tissue lesions for both CT-guided CNB (87.0% vs. 59.5%, p=0.002) and incisional biopsy (87.0% vs. 77.3%, p=0.43). The accuracy of CT-guided CNB for specific diagnosis of benign soft-tissue tumours as well as infection and inflammation was relatively low. CONCLUSION. CT-guided CNB is safe, easy to perform, efficient, and less invasive, and should be considered as a first-line biopsy for musculoskeletal lesions.
目的。比较计算机断层扫描（CT）引导下的粗针活检（CNB）与切开活检在诊断肌肉骨骼病变中的应用。方法。将62名男性和50名年龄在12至83岁（平均45岁）接受CT引导下CNB的女性与31名男性和33名年龄在9至81岁（平均53岁）接受切开活检的女性进行比较。所有标本均有最终病理报告以供对比。比较内容包括：（1）诊断率；（2）区分良性与恶性病变的准确性；（3）区分低级别与高级别肉瘤的准确性；（4）组织学诊断的准确性；（5）并发症和重复活检率。结果。CT引导下CNB与切开活检的诊断率无显著差异（92.9%对96.9%，p = 0.33），区分良性与恶性病变的准确性（100%对98.4%，p = 0.37）、区分低级别与高级别肉瘤的准确性（100%对100%，p = 1.00）、特异性诊断的准确性（75.9%对85.2%，p = 0.17）、重复活检率（6.3%对4.7%，p = 0.75）以及并发症率（0.9%对4.7%，p = 0.14）也无显著差异。对于CT引导下CNB和切开活检，骨病变的特异性诊断准确性均高于软组织病变（分别为87.0%对59.5%，p = 0.002；87.0%对77.3%，p = 0.43）。CT引导下CNB对良性软组织肿瘤以及感染和炎症的特异性诊断准确性相对较低。结论。CT引导下CNB安全、操作简便、高效且侵入性较小，应被视为肌肉骨骼病变活检的一线方法。
