Liang Yun, Liu Peng, Jiang Li-Bo, Wang Hou-Lei, Hu An-Nan, Zhou Xiao-Gang, Li Xi-Lei, Lin Hong, Wu Dong, Dong Jian
Department of Orthopaedics, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Radiology, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China.
Orthop Surg. 2019 Feb;11(1):60-65. doi: 10.1111/os.12418. Epub 2019 Feb 14.
A retrospective study was designed to evaluate the effectiveness of CT-guided core needle biopsy in diagnosing spinal lesions through comparison with C-arm guidance.
From April 2013 to July 2017, a total of 188 patients, who suffered from spinal lesions or had malignant tumor history with a new spinal fracture, were included in this study. There were 96 men and 92 women, with an average of 57.1 years. A total of 238 core needle biopsies were performed. A total of 140 core needle biopsies were carried out under C-arm guidance in 102 patients (group 1); 98 core needle biopsies were carried out under CT guidance in 86 patients (group 2); 108 core needle biopsies were performed in thoracic vertebrae, 116 were in lumbar vertebrae, and 14 were in sacral vertebrae. Seventy-eight patients accepted surgical treatment after biopsies. For these patients, the histological pathologies of the biopsy and surgery were compared to evaluate the accuracy of the biopsy. For the other 110 patients who did not receive surgical treatment, the treatment response and the clinical course were used to evaluate the accuracy of the biopsy. The success rate, the diagnostic accuracy rate, the true positive/negative rate, and complications of the two groups were calculated and compared.
There were no significant differences in sex, age, and lesion sites between the C-arm guidance group (group 1) and the CT guidance group (group 2). There were no complications in the two groups. Pathological diagnoses were established in 232 of 238 biopsies. They revealed that 52 were primary malignant tumors, 12 were benign tumors, 70 were metastatic tumors, 4 were tuberculosis, and 94 were classified as "other." The success rate of group 2 was higher than that of group 1, but it was not statistically significant (95.7% vs 100%; P = 0.098). According to the final diagnosis, the diagnostic accuracy rates were calculated and compared. There was no significant difference between the two groups (95.5% vs 96.9%; P = 0.835). The kappa coefficient was used to analyze the concordance between the histological pathologies of the biopsy and the final diagnosis in the two groups. The kappa values of the two group were 0.909 and 0.939, respectively. The results showed good consistency in both groups, but seemed better for group 2.
CT-guided core needle biopsy is a relatively safe and effective procedure for diagnosing spinal lesions with a high diagnostic accuracy rate and few complications.
设计一项回顾性研究，通过与C形臂引导相比较，评估CT引导下的粗针穿刺活检在诊断脊柱病变中的有效性。
2013年4月至2017年7月，本研究共纳入188例患有脊柱病变或有恶性肿瘤病史且伴有新发脊柱骨折的患者。其中男性96例，女性92例，平均年龄57.1岁。共进行了238次粗针穿刺活检。102例患者（第1组）在C形臂引导下进行了140次粗针穿刺活检；86例患者（第2组）在CT引导下进行了98次粗针穿刺活检；胸椎穿刺活检108次，腰椎穿刺活检116次，骶椎穿刺活检14次。78例患者在活检后接受了手术治疗。对于这些患者，比较活检和手术的组织病理学结果以评估活检的准确性。对于另外110例未接受手术治疗的患者，利用治疗反应和临床病程来评估活检的准确性。计算并比较两组的成功率、诊断准确率、真阳性/阴性率及并发症。
C形臂引导组（第1组）和CT引导组（第2组）在性别、年龄和病变部位方面无显著差异。两组均未出现并发症。238次活检中有232次确立了病理诊断。结果显示，原发性恶性肿瘤52例，良性肿瘤12例，转移性肿瘤70例，结核4例，其他94例。第2组的成功率高于第1组，但差异无统计学意义（95.7%对100%；P = 0.098）。根据最终诊断，计算并比较两组的诊断准确率。两组之间无显著差异（95.5%对96.9%；P = 0.835）。采用kappa系数分析两组活检组织病理学与最终诊断之间的一致性。两组的kappa值分别为0.909和0.939。结果显示两组一致性均良好，但第2组似乎更佳。
CT引导下的粗针穿刺活检是诊断脊柱病变的一种相对安全有效的方法，诊断准确率高，并发症少。
