1 Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Rm C159, Ottawa, ON K1Y 4E9, Canada.
2 Department of Anatomical Pathology, The Ottawa Hospital, Ottawa, ON, Canada.
AJR Am J Roentgenol. 2019 Mar;212(3):570-575. doi: 10.2214/AJR.18.20221. Epub 2019 Jan 15.
The objective of this study was to compare diagnostic yield and complication rate in needle biopsy (NB) of renal hilar and cortical masses.
With institutional review board approval, we retrospectively studied 195 patients (120 men, 75 women; mean age ± SD, 67 ± 13 years old) who underwent ultrasound-guided renal mass NB between January 2013 and December 2017. Operator years of experience, biopsy technique (coaxial or successive), needle gauge (22-gauge fine-needle aspiration, 18-gauge core-needle, or both), number of passes, postprocedural complication, and histopathologic diagnoses were recorded. A radiologist who was blinded to histopathologic diagnoses recorded mass location (upper pole, interpolar region, lower pole) and percentage of hilar involvement. Comparisons were performed using independent t and chi-square tests.
Of the masses biopsied, 5.6% (11/195) were 100% hilar (mean hilar involvement, 20.8% ± 29.8%; range, 0-100%). Mean lesion size was 44 ± 27 mm (range, 12-157 mm). NB diagnosis was established in 84.6% (165/195) of masses, and 15.4% (30/195) of biopsies were inconclusive, with no association with size (p = 0.55) or percentage of hilar involvement (p = 0.756). In the purely hilar masses, diagnosis was established in 72.7% (8/11) compared with 85.3% (157/184) with any cortical involvement (p = 0.265). There was no association between diagnosis and operator years of experience, biopsy technique, needle gauge, or number of passes (p > 0.05). Bleeding occurred after biopsy in 7.7% (15/195) of cases, was associated with percentage of hilar involvement (39.3% ± 44.9% vs 19.3% ± 27.8%; p = 0.012), and was more common in purely hilar masses (36.4% [4/11] vs 5.6% [11/195]; p < 0.001). Complications were not associated with any other feature (p > 0.05).
Percutaneous biopsy of renal hilar masses is technically feasible with diagnostic yield similar to that of cortical masses but with postprocedural bleeding more often than what is seen with cortical masses.
本研究旨在比较肾门和皮质肿块的经皮穿刺活检（NB）的诊断率和并发症发生率。
本研究经机构审查委员会批准，回顾性分析了 2013 年 1 月至 2017 年 12 月期间接受超声引导下肾肿块 NB 的 195 例患者（男 120 例，女 75 例；平均年龄 ± 标准差，67 ± 13 岁）。记录操作者的工作年限、活检技术（同轴或连续）、活检针规格（22 号细针抽吸、18 号芯针或两者兼有）、穿刺次数、术后并发症和组织病理学诊断。一名对组织病理学诊断不知情的放射科医生记录了肿块的位置（上极、极间区、下极）和肾门受累的百分比。采用独立 t 检验和卡方检验进行比较。
在接受活检的肿块中，5.6%（11/195）为 100%肾门（平均肾门受累 20.8% ± 29.8%；范围，0-100%）。病变大小的平均值为 44 ± 27 mm（范围，12-157 mm）。84.6%（165/195）的肿块可明确诊断，15.4%（30/195）的活检结果不确定，与肿块大小（p = 0.55）或肾门受累百分比（p = 0.756）无关。在单纯肾门肿块中，72.7%（8/11）可明确诊断，而任何皮质受累（p = 0.265）时的诊断率为 85.3%（157/184）。诊断与操作者的工作年限、活检技术、活检针规格或穿刺次数无关（p > 0.05）。195 例患者中有 7.7%（15/195）在活检后出现出血，与肾门受累百分比相关（39.3% ± 44.9% vs 19.3% ± 27.8%；p = 0.012），且更常见于单纯肾门肿块（36.4% [4/11] vs 5.6% [11/195]；p < 0.001）。并发症与其他任何特征均无关（p > 0.05）。
经皮肾门肿块穿刺活检技术上可行，诊断率与皮质肿块相似，但术后出血较皮质肿块更为常见。
