Interiano Rodrigo B, Loh Amos H P, Hinkle Nathan, Wahid Fazal N, Malkan Alpin D, Bahrami Armita, Jenkins Jesse J, Mao Shenghua, Wu Jianrong, Proctor Kimberly, Santana Victor M, Pappo Alberto S, Gold Robert E, Davidoff Andrew M
Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee; Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
Cancer. 2015 Apr 1;121(7):1098-107. doi: 10.1002/cncr.29167. Epub 2014 Dec 18.
Tumor biopsies are central to the diagnosis and management of cancer and are critical to efforts in personalized medicine and targeted therapeutics. In the current study, the authors sought to evaluate the safety and accuracy of biopsies in children with cancer.
All biopsies performed in children at the study institution with a suspected or established diagnosis of cancer from 2003 through 2012 were reviewed retrospectively. Patient characteristics and disease-related and procedure-related factors were correlated with procedure-related complications and diagnostic accuracy using logistic regression analysis.
A total of 1073 biopsies were performed in 808 patients. Of 1025 biopsies with adequate follow-up, 79 (7.7%) were associated with an adverse event, 35 (3.4%) of which were minor (grade 1-2) and 32 (3.1%) of which were major (grade 3-4) (grading was performed according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0]). The most common major adverse events were blood transfusion (>10 mL/kg; 24 cases) and infection requiring intravenous antibiotics (6 cases). Eleven deaths (1.4%) occurred within 30 days after the procedure, but the procedure may have contributed to the outcome in only 2 cases. A total of 926 biopsies (90.3%) provided definitive histologic diagnoses. Using multivariable analysis, biopsy site, preprocedure hematocrit level, and body mass index were found to be associated with the risk of postprocedural complications (P<.0001, P<.0001, and P =.0029, respectively). Excisional biopsy and biopsy site were found to be independently associated with obtaining a diagnostic result (P =.0002 and P =.0008, respectively).
Tumor biopsies in children with cancer are associated with a low incidence of complications and a high rate of diagnostic accuracy. The predictive factors identified for adverse outcomes may aid in risk assessment and preprocedural counseling.
肿瘤活检对于癌症的诊断和治疗至关重要，对个性化医疗和靶向治疗也起着关键作用。在本研究中，作者旨在评估癌症患儿活检的安全性和准确性。
回顾性分析了2003年至2012年在研究机构对疑似或确诊癌症的儿童进行的所有活检。使用逻辑回归分析将患者特征、疾病相关因素和手术相关因素与手术相关并发症及诊断准确性进行关联。
共对808例患者进行了1073次活检。在1025次有充分随访的活检中，79次（7.7%）与不良事件相关，其中35次（3.4%）为轻微不良事件（1 - 2级），32次（3.1%）为严重不良事件（3 - 4级）（不良事件分级依据美国国立癌症研究所不良事件通用术语标准[第4.0版]）。最常见的严重不良事件是输血（>10 mL/kg；24例）和需要静脉使用抗生素的感染（6例）。11例（1.4%）患者在手术后30天内死亡，但手术可能仅导致了2例死亡。共有926次活检（90.3%）提供了明确的组织学诊断。通过多变量分析发现，活检部位、术前血细胞比容水平和体重指数与术后并发症风险相关（分别为P <.0001、P <.0001和P =.0029）。切除活检和活检部位被发现与获得诊断结果独立相关（分别为P =.0002和P =.0008）。
癌症患儿的肿瘤活检并发症发生率低，诊断准确率高。确定的不良结局预测因素可能有助于风险评估和术前咨询。
