Srisawat Phutsapong, Veeraphun Puwadol, Punyaratabandhu Thipachart, Chareonvareekul Supichai, Songpattanasilpa Thawee, Sritanabutr Pipat, Pipithkul Sahachart
J Med Assoc Thai. 2014 Feb;97 Suppl 2:S30-8.
The biopsy is a simple but critical step in the diagnosis of the musculoskeletal lesions. Although the open incisional biopsy traditionally has been considered the gold standard with high diagnostic accuracy, an alternative, the closed needle biopsy (CNB), has been developed and widely used as it can be performed at an outpatient clinic under local anesthesia or in combination with the image guidance. In the present study, the authors purpose to study the diagnostic accuracy of CNB without real-time image-guidance at an outpatient clinic by comparing it with open incisional biopsy in musculoskeletal sarcoma patients.
The authors retrospectively reviewed 200 biopsy cases of sarcoma patients since 2002-2011. There were 105 cases of open incisional biopsy 105 cases and 95 cases of CNB. The diagnostic accuracies of both mentioned methods were compared statistically in four aspects of histopathology: nature (benign or malignant), specific diagnosis, histological type and histological grade. The gold standard was afinal pathological diagnosis of the resected specimens receivedfrom definite surgery correlated with clinical findings and imnaging studies.
The diagnostic accuracies of open incisional biopsy were 97.14% for nature, 89.52% for specific diagnosis, 89.52% for histological type, 88.57% for histological grade and the diagnostic accuracies of CNB were 96.84%, 89.47%, 88.42%, 86.32%, respectively. There was no significant statistical difference between the two methods in all histological aspects (p-value >0.05). The diagnostic yields of both methods were 98.13% for open incisional biopsy, 97.94% for CNB and there was no significant statistical difference (p-value >0.05). There were 6 cases (3%)for overall major errors, 3 cases (2.86%) firom open incisional biopsy and 3 cases (3.16%) from CNB. There were 18 cases (9%)for minor errors, 9 cases (8.57%) from open incisional biopsy and 9 cases (9.47%) from CNB. There was no biopsy related complication in either method.
The office-based CNB diagnosis of musculoskeletal sarcoma can achieve an acceptably high diagnostic accuracy rate compared with open incisional biopsy.
活检是肌肉骨骼病变诊断中一个简单但关键的步骤。尽管传统上开放性切开活检被认为是诊断准确性高的金标准，但一种替代方法——闭合针吸活检（CNB）已被开发并广泛应用，因为它可以在门诊局部麻醉下或结合图像引导进行。在本研究中，作者旨在通过将门诊无实时图像引导的CNB与肌肉骨骼肉瘤患者的开放性切开活检进行比较，研究其诊断准确性。
作者回顾性分析了2002年至2011年期间200例肉瘤患者的活检病例。其中开放性切开活检105例，CNB 95例。从组织病理学的四个方面对上述两种方法的诊断准确性进行统计学比较：性质（良性或恶性）、明确诊断、组织学类型和组织学分级。金标准是与临床发现和影像学研究相关的确定性手术切除标本的最终病理诊断。
开放性切开活检在性质方面的诊断准确性为97.14%，明确诊断为89.52%，组织学类型为89.52%，组织学分级为88.57%；CNB的诊断准确性分别为96.84%、89.47%、88.42%、86.32%。两种方法在所有组织学方面均无显著统计学差异（p值>0.05）。两种方法的诊断阳性率开放性切开活检为98.13%，CNB为97.94%，无显著统计学差异（p值>0.05）。总体主要错误有6例（3%），开放性切开活检3例（2.86%），CNB 3例（3.16%）。轻微错误有18例（9%），开放性切开活检9例（8.57%），CNB 9例（9.47%）。两种方法均无活检相关并发症。
与开放性切开活检相比，门诊基于CNB的肌肉骨骼肉瘤诊断可达到可接受的高诊断准确率。
