Geldenhuys Laurette, Nicholson Peter, Sinha Namita, Dini Angela, Doucette Steve, Alfaadhel Talal, Keough Valerie, West Michael
Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia Canada.
Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia Canada.
Can J Kidney Health Dis. 2015 Mar 13;2:8. doi: 10.1186/s40697-015-0043-z. eCollection 2015.
An adequate renal biopsy is essential for diagnosis and treatment of medical renal disease.
We evaluated two initiatives to improve adequacy of renal biopsy samples at our centre.
Retrospective determination of renal biopsy adequacy.
Queen Elizabeth II Health Sciences Centre.
Patients undergoing medical renal biopsies.
Renal biopsy adequacy.
The first initiative was to restrict the performance of biopsies to a smaller group of radiologists and to include a comment on biopsy adequacy in every pathology report. The second initiative was to introduce on-site adequacy assessment by a medical laboratory technologist. Native renal and allograft biopsy adequacies were calculated for three periods: 1) baseline, October 2005 to September 2006; 2) after implementation of the first initiative, January 2007 to September 2011; and 3) after implementation of the second initiative, October 2011 to September 2012. A subset of native renal biopsies was examined to determine if there was a relationship between adequacy and number of passes.
The percentages of adequate native renal biopsies during the first, second, and third periods were 31%, 72% and 90%, respectively. This represents a significant increase (40%, p < 0.0001) in adequacy following the first initiative, and another significant increase (18%, p = 0.0003) following the second initiative. The percentages of adequate renal allograft biopsies during the first, second, and third periods were 75%, 56% and 69%, respectively. These changes in adequacy were not statistically significant. In the subset of native renal biopsies examined, a biopsy comprising more than three cores was not associated with increase in adequacy.
The most important limitation is the lack of generally accepted and applied adequacy criteria limiting generalizability of our findings.
Restricting the performance of biopsies to subspecialist operators, including an adequacy statement in the renal biopsy report and on-site adequacy assessment were effective in significantly improving native renal biopsy adequacy. This improvement appeared unrelated to an increase in the number of passes taken with a biopsy needle. Neither initiative improved the low adequacy of allograft biopsies.
足够的肾活检对于诊断和治疗内科肾病至关重要。
我们评估了两项举措，以提高我们中心肾活检样本的充足性。
肾活检充足性的回顾性测定。
伊丽莎白二世健康科学中心。
接受内科肾活检的患者。
肾活检充足性。
第一项举措是将活检操作限制在一小部分放射科医生中，并在每份病理报告中包含关于活检充足性的评论。第二项举措是引入医学检验技师进行现场充足性评估。计算了三个时间段的原发性肾活检和同种异体肾移植活检的充足率：1）基线期，2005年10月至2006年9月；2）第一项举措实施后，2007年1月至2011年9月；3）第二项举措实施后，2011年10月至2012年9月。对原发性肾活检的一个子集进行检查，以确定充足性与穿刺次数之间是否存在关系。
第一、第二和第三阶段原发性肾活检充足的百分比分别为31%、72%和90%。这表明在第一项举措后充足率有显著提高（40%，p<0.0001），在第二项举措后又有显著提高（18%，p = 0.0003）。第一、第二和第三阶段同种异体肾移植活检充足的百分比分别为75%、56%和69%。这些充足率的变化无统计学意义。在检查的原发性肾活检子集中，包含超过三个芯的活检与充足率的增加无关。
最重要的局限性是缺乏普遍接受和应用的充足性标准，限制了我们研究结果的普遍性。
将活检操作限制在专科医生，在肾活检报告中包含充足性声明以及进行现场充足性评估，有效地显著提高了原发性肾活检的充足性。这种改善似乎与活检针穿刺次数的增加无关。两项举措均未改善同种异体肾移植活检的低充足率。
