Shao Haibo, McCarthy Colin, Wehrenberg-Klee Eric, Thabet Ashraf, Uppot Raul, Dawson Steven, Arellano Ronald S
Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China; Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 293, Boston, MA 02114.
Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 293, Boston, MA 02114.
J Vasc Interv Radiol. 2018 Oct;29(10):1429-1436. doi: 10.1016/j.jvir.2018.03.028. Epub 2018 Aug 31.
To assess the technical success rate, diagnostic yield, and clinical value of computed tomography (CT)-guided percutaneous needle biopsy (PNB) for retroperitoneal and pelvic lymphadenopathy.
This retrospective study included 344 patients evaluated for safety and technique and 334 patients evaluated for diagnostic yield and clinical analyses. PNBs were performed with fine-needle aspiration (FNA) in 315 patients and with core biopsy in 333 patients. Follow-up analyses, including repeat biopsy, open surgery, imaging, and clinical indicators, were conducted for 94 patients who had nonspecific malignant or benign results. Diagnostic yields were calculated based on biopsy and follow-up results. Factors associated with final diagnoses were compared and modeled by multivariate analysis.
Technical success rate was 99.7%. Thirty-nine patients (11.3%) had minor complications. From biopsy results and follow-up analyses, final malignant diagnoses were determined for 281 patients (84.1%). Overall sensitivity, specificity, and accuracy rates of PNB were 91.5%, 100%, and 92.8%, respectively. For patients with a history of malignancy, the likelihood of nodal involvement was 84.6% and that of a new, different malignancy was 3.7%. Older age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00-1.05), history of malignancy (OR, 3.44; 95% CI, 1.71-6.92), multiple lymph nodes (LNs; OR, 2.65; 95% CI, 1.38-5.09), and new or enlarging LNs (OR, 2.62; 95% CI, 1.25-5.48) were independent risk factors for malignancy diagnosis.
CT-guided PNB is a safe, effective procedure that can achieve high diagnostic yields for patients with retroperitoneal and pelvic lymphadenopathy.
评估计算机断层扫描（CT）引导下经皮穿刺针吸活检（PNB）对腹膜后和盆腔淋巴结病的技术成功率、诊断率及临床价值。
本回顾性研究纳入344例评估安全性和技术的患者以及334例评估诊断率和进行临床分析的患者。315例患者采用细针穿刺抽吸（FNA）进行PNB，333例患者采用粗针活检。对94例活检结果为非特异性恶性或良性的患者进行了包括重复活检、开放手术、影像学检查和临床指标的随访分析。根据活检和随访结果计算诊断率。通过多因素分析比较并建立与最终诊断相关的因素模型。
技术成功率为99.7%。39例患者（11.3%）出现轻微并发症。根据活检结果和随访分析，281例患者（84.1%）被确定为最终恶性诊断。PNB的总体敏感性、特异性和准确率分别为91.5%、100%和92.8%。有恶性肿瘤病史的患者，淋巴结受累的可能性为84.6%，出现新的、不同恶性肿瘤的可能性为3.7%。年龄较大（优势比[OR]，1.03；95%置信区间[CI]，1.00 - 1.05）、有恶性肿瘤病史（OR，3.44；95% CI，1.71 - 6.92）、多个淋巴结（LNs；OR，2.65；95% CI，1.38 - 5.09）以及新出现或增大的LNs（OR，2.62；95% CI，1.25 - 5.48）是恶性诊断的独立危险因素。
CT引导下PNB是一种安全、有效的方法，对于腹膜后和盆腔淋巴结病患者可获得较高的诊断率。
