Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Abdom Radiol (NY). 2019 Jan;44(1):333-336. doi: 10.1007/s00261-018-1725-7.
To evaluate safety and diagnostic yield of percutaneous CT-guided biopsy of extrarenal upper urinary tract lesions.
Retrospective review of our institutional database of image-guided biopsies yielded 44 CT-guided percutaneous biopsies in 44 unique patients that targeted ureteral (30, 68%) or other non-renal upper urinary tract lesions (14, 32%) between January 1, 2000 and May 1, 2017. Indications, pre-biopsy imaging, biopsy technique, peri-procedural antithrombotic use, complications including bleeding defined by Society of Interventional Radiology criteria, pathology results, and subsequent imaging were reviewed up to 3 months after the procedure to evaluate safety and diagnostic yield.
Mean patient age was 66 (range 27-88) and 23/44 patients were male. The majority (34/44) of lesions were sampled with an 18-gauge biopsy device via a 17-gauge introducer needle, and the remaining 10/44 lesions were sampled with a 19/20 gauge system. The mean number of core samples obtained was 4 (range 2-10). No major complications occurred. Specifically, no patient developed a urine leak or urinary obstruction. Minor complications occurred in 3/44 (7%) biopsies, all retroperitoneal hemorrhages that did not require transfusion or other intervention. Biopsy was adequate for pathologic examination in 41 of 44 (93%) cases. Among patients undergoing surgical resection, biopsy diagnosis was concordant with surgical pathology in 9/10 (90%) cases and discordant in 1/10 (10%).
CT-guided percutaneous biopsy of upper urinary tract lesions can be performed safely, with high diagnostic yield, and with a high rate of concordance on subsequent surgical pathology.
评估经皮 CT 引导下肾外上尿路病变活检的安全性和诊断率。
回顾性分析 2000 年 1 月至 2017 年 5 月期间，我们机构影像引导活检数据库中 44 例经皮 CT 引导下穿刺活检的病例，44 例患者中，30 例（68%）为输尿管病变，14 例（32%）为其他非肾上尿路病变。评估安全性和诊断率时，我们对术前影像学检查、活检技术、围手术期抗血栓治疗、包括按介入放射学会标准定义的出血等并发症、术后 3 个月内的病理结果及后续影像学检查进行了回顾。
患者平均年龄为 66 岁（27-88 岁），23 例为男性。大多数（34/44）病变采用 18 号活检针经 17 号导针取样，其余 10 例采用 19/20 号系统取样。平均活检标本数量为 4 个（2-10 个）。无重大并发症发生。具体来说，无患者发生尿漏或尿路梗阻。3/44（7%）例活检出现轻微并发症，均为腹膜后血肿，无需输血或其他干预。44 例中有 41 例（93%）活检标本可用于病理检查。在接受手术切除的患者中，活检诊断与手术病理的一致性为 9/10（90%），不一致为 1/10（10%）。
经皮 CT 引导下肾外上尿路病变活检是一种安全、具有高诊断率且与后续手术病理一致性较高的方法。
