Cassol Clarissa A, Braga Juarez R, Dabbo Samer, Khalili K, Avila-Casado C
Department of Pathology, Laboratory Medicine, University of Toronto, Canada.
Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada.
Ann Diagn Pathol. 2017 Jun;28:1-6. doi: 10.1016/j.anndiagpath.2017.02.002. Epub 2017 Feb 5.
Percutaneous biopsy is a key diagnostic tool for both native and allograft kidney diseases. Adequacy criteria vary, but at a minimum, a biopsy should allow the pathologist to reach a diagnosis and provide prognostic information such as the degree of interstitial fibrosis and tubular atrophy (IF/TA) and percentage of glomerulosclerosis. Whereas most studies use glomerular counts as a surrogate for biopsy adequacy, the amount and preservation of tubulointerstitium is equally important, considering IF/TA is a major prognostic parameter for most medical renal diseases. Many studies have compared the diagnostic adequacy of different gauge needles; however few have investigated performance differences between same gauge needles. In this study, we retrospectively analyzed 235 renal biopsies performed at a single center in Canada over 2years to compare the utilization, safety, diagnostic and prognostic performance of two 18-gauge needles in native and allograft kidney biopsies. We found no significant difference in needle utilization between native and allograft kidneys, or between trainees and staff radiologists. The total tissue yielded area, glomerular counts, percentage of inadequate biopsies and number of passes were similar; however the number of cases in which IF/TA evaluation was deemed not possible was higher for biopsies using disposable instrument needles (4.3% vs. 0%; p=0.01). These also showed greater number of tissue fragments (median 4 for reusable vs 3 for disposable; p=0.04). We postulate that the increased tissue fragmentation might have impaired the pathologists ability to accurately assess interstitial fibrosis and tubular atrophy in biopsies obtained with the disposable instrument needles.
经皮肾活检是诊断原发性和移植肾疾病的关键工具。活检充分性标准各不相同，但至少活检应能让病理学家做出诊断并提供预后信息，如间质纤维化和肾小管萎缩（IF/TA）程度以及肾小球硬化百分比。尽管大多数研究将肾小球数量作为活检充分性的替代指标，但考虑到IF/TA是大多数内科肾脏疾病的主要预后参数，肾小管间质的数量和保存情况同样重要。许多研究比较了不同规格穿刺针的诊断充分性；然而，很少有研究调查相同规格穿刺针之间的性能差异。在本研究中，我们回顾性分析了加拿大一个中心在两年内进行的235例肾活检，以比较两种18G穿刺针在原发性和移植肾活检中的使用情况、安全性、诊断和预后性能。我们发现，原发性肾和移植肾之间，以及实习医生和放射科工作人员之间，穿刺针的使用情况没有显著差异。总的组织取材面积、肾小球数量、活检不充分的百分比和穿刺次数相似；然而，使用一次性器械穿刺针活检时，无法进行IF/TA评估的病例数更高（4.3%对0%；p=0.01）。这些病例的组织碎片数量也更多（可重复使用穿刺针的中位数为4个，一次性穿刺针为3个；p=0.04）。我们推测，组织碎片增加可能会削弱病理学家准确评估使用一次性器械穿刺针获取的活检组织中间质纤维化和肾小管萎缩的能力。
