Chang Connie Y, Huang Ambrose J, Bredella Miriam A, Torriani Martin, Halpern Elkan F, Rosenthal Daniel I, Springfield Dempsey S
Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
Skeletal Radiol. 2015 Dec;44(12):1795-803. doi: 10.1007/s00256-015-2235-0. Epub 2015 Sep 4.
To study non-diagnostic CT-guided musculoskeletal biopsies and take steps to minimize them. Specifically we asked: (1) What malignant diagnoses have a higher non-diagnostic rate? (2) What factors of a non-diagnostic biopsy may warrant more aggressive pursuit? (3) Do intra-procedural frozen pathology (FP) or point-of-care (POC) cytology reduce the non-diagnostic biopsy rate?
This study was IRB-approved and HIPAA-compliant. We retrospectively reviewed 963 consecutive CT-guided musculoskeletal biopsies. We categorized pathology results as malignant, benign, or non-diagnostic and recorded use of FP or POC cytology. Initial biopsy indication, final diagnosis, method of obtaining the final diagnosis of non-diagnostic biopsies, age of the patient, and years of biopsy attending experience were recorded. Groups were compared using Pearson's χ(2) test or Fisher's exact test.
In all, 140 of 963 (15%) biopsies were non-diagnostic. Lymphoma resulted in more non-diagnostic biopsies (P < 0.0001). While 67% of non-diagnostic biopsies yielded benign diagnoses, 33% yielded malignant diagnoses. Patients whose percutaneous biopsy was indicated due to the clinical context without malignancy history almost always generated benign results (96%). Whereas 56% of biopsies whose indication was an imaging finding of a treatable lesion were malignant, 20% of biopsies whose indication was a history of malignancy were malignant. There was no statistically significant difference in the nondiagnostic biopsy rates of pediatric versus adult patients (P = 0.8) and of biopsy attendings with fewer versus more years of experience (P = 0.5). The non-diagnostic rates of biopsies with FP (8%), POC cytology (25%), or neither (24%) were significantly different (P < 0.0001).
Lymphoma is the malignant diagnosis most likely to result in a non-diagnostic biopsy. If the clinical and radiologic suspicion for malignancy is high, repeat biopsy is warranted. If the clinical context suggests a benign lesion, a non-diagnostic biopsy may be considered reassuring. Frozen pathology may decrease the non-diagnostic biopsy rate.
研究非诊断性CT引导下的肌肉骨骼活检，并采取措施将其降至最低。具体而言，我们提出以下问题：（1）哪些恶性诊断的非诊断率较高？（2）非诊断性活检的哪些因素可能需要更积极地追查？（3）术中冷冻病理（FP）或即时检验（POC）细胞学检查能否降低非诊断性活检率？
本研究经机构审查委员会（IRB）批准并符合健康保险流通与责任法案（HIPAA）。我们回顾性分析了963例连续的CT引导下肌肉骨骼活检病例。我们将病理结果分为恶性、良性或非诊断性，并记录FP或POC细胞学检查的使用情况。记录初始活检指征、最终诊断、非诊断性活检最终诊断的获取方法、患者年龄以及活检主治医生的工作年限。采用Pearson卡方检验或Fisher精确检验对各组进行比较。
963例活检中共有140例（15%）为非诊断性。淋巴瘤导致的非诊断性活检更多（P < 0.0001）。虽然67%的非诊断性活检得出良性诊断，但33%得出恶性诊断。因临床情况而进行经皮活检且无恶性肿瘤病史的患者几乎总是得出良性结果（96%）。而因影像学发现可治疗病变而进行活检的病例中56%为恶性，因有恶性肿瘤病史而进行活检的病例中20%为恶性。儿科患者与成年患者的非诊断性活检率无统计学显著差异（P = 0.8），活检主治医生工作年限少与多的非诊断性活检率也无统计学显著差异（P = 0.5）。采用FP（8%）、POC细胞学检查（25%）或两者均未采用（24%）的活检非诊断率有显著差异（P < 0.0001）。
淋巴瘤是最有可能导致非诊断性活检的恶性诊断。如果临床和影像学对恶性肿瘤的怀疑度高，则有必要重复活检。如果临床情况提示为良性病变，非诊断性活检可能被认为是令人安心的。冷冻病理检查可能会降低非诊断性活检率。
