Aj Lawrence, Kalra Naveen, Bhatia Anmol, Srinivasan Radhika, Gulati Ajay, Kapoor Rakesh, Gupta Vikas, Dhiman Radha K, Chawla Yogesh, Khandelwal Niranjan
Departments of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
Cytology and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
J Clin Exp Hepatol. 2019 Sep-Oct;9(5):547-553. doi: 10.1016/j.jceh.2019.01.003. Epub 2019 Jan 25.
The aim of this study was to compare the diagnostic adequacy of computed tomography (CT)-ultrasound (US) fusion image-guided fine needle aspiration (FNA) and US-guided FNA in patients with suspected hepatic metastases.
Thirty consecutive patients of either sex with known or unknown primary malignancy suspected of having liver metastases on both US and CT, whose multiphasic contrast-enhanced computed tomography was performed using a 64-slice or a higher slice CT scanner, and who were referred for percutaneous FNA were included in this prospective study approved by the institutional review board of the study institute. CT-ultrasound fusion image-guided FNA of the largest lesion using electromagnetic tracking and with freehand ultrasound-guided FNA were performed in the same sitting. Value of fitness, which is a rough estimate of how well the fusion has been achieved, was recorded. Diagnostic adequacy of smears was assessed by a scoring system based on cellular material, background blood/clot, degree of cellular degeneration or trauma, and retention of architecture.
The size of the lesions ranged from 1 to 10 cm, and the depth of location of the lesions ranged from 1.4 to 9.3 cm. The fusion fitness values ranged from 1.2 to 10 mm. The scores of the smears did not correlate with lesion size, depth of location, and fusion fitness value. Diagnostic adequacy was seen in 90% and 93.3% of lesions sampled by fusion image guidance and ultrasound guidance, respectively (p = 0.655). All the lesions that yielded inadequate smears by fusion guidance were deep-seated lesions (>5 cm). All the lesions that yielded inadequate smears by ultrasound guidance were small lesions (<3 cm). No complications were encountered in any of the patients.
Fusion image-guided FNA is a safe procedure with a high diagnostic adequacy rate. Fusion image-guided FNA is not better than US-guided FNA for conspicuous hepatic lesions; however, it may be useful in inconspicuous lesions.
本研究旨在比较计算机断层扫描（CT）-超声（US）融合图像引导下细针穿刺抽吸（FNA）与超声引导下FNA对疑似肝转移患者的诊断充分性。
本前瞻性研究经研究机构的机构审查委员会批准，纳入了30例连续的患者，这些患者无论性别，已知或未知原发性恶性肿瘤，超声和CT均怀疑有肝转移，使用64层或更高层CT扫描仪进行了多期对比增强计算机断层扫描，并被转诊进行经皮FNA。在同一次就诊中，使用电磁跟踪对最大病变进行CT-超声融合图像引导下FNA，并进行徒手超声引导下FNA。记录融合度值，该值是对融合完成程度的粗略估计。通过基于细胞材料、背景血液/凝块、细胞变性或创伤程度以及结构保留情况的评分系统评估涂片的诊断充分性。
病变大小范围为1至10厘米，病变位置深度范围为1.4至9.3厘米。融合度值范围为1.2至10毫米。涂片评分与病变大小、位置深度和融合度值无关。融合图像引导和超声引导取样的病变中，诊断充分性分别为90%和93.3%（p = 0.655）。融合引导下涂片不充分的所有病变均为深部病变（>5厘米）。超声引导下涂片不充分的所有病变均为小病变（<3厘米）。所有患者均未出现并发症。
融合图像引导下FNA是一种安全的操作，诊断充分率高。对于明显的肝病变，融合图像引导下FNA并不优于超声引导下FNA；然而，它可能对不明显的病变有用。
