Han Jie, Feng Xiao-Li, Xu Tian-Yu, Feng Wen-Qi, Liu Meng-Jia, Wang Bo, Qiu Ting-Lin, Wang Yong
Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
J Thorac Dis. 2019 Dec;11(12):5290-5299. doi: 10.21037/jtd.2019.11.51.
Given low incidence and high heterogeneity, the treatment strategies of anterior mediastinal masses (AMMs) are diverse based on pathology. The purpose of the study is to evaluate the usefulness of contrast-enhanced ultrasound (CEUS) in transthoracic biopsy of malignant AMMs when compared with that of ultrasound (US) alone and to screen lesions that are more suitable for CEUS evaluation and guidance.
We reviewed all the US- and CEUS-guided transthoracic core needle biopsy (CNB) of AMMs performed in National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between July 2013 and April 2019. A total of 68 patients (mean age 36 years; male-female ration 1.6:1) who were suspected with malignant AMMs were enrolled in the study. Among them, 20 patients received pre-biopsy CEUS examination (CEUS group); 48 patients underwent conventional US examination and guidance (US group). Demographic, radiologic, pathologic, medical records, and biopsy procedure details were retrospectively reviewed and compared between the two groups.
The display of internal necrosis areas was significantly improved when compared with that of the conventional US (70%, 30%; P=0.008). Specifically, CEUS improved the diagnostic accuracy of US-guided transthoracic biopsy (95.0%, 79.2%; P=0.210) and especially for AMMs exceeding 10 cm (100%, 68.2%; P=0.040) and carcinoma (100%, 0%; P=0.048). The number of punctures in US group and CEUS group was 2.6 and 4.4 times, respectively (P<0.001). In case of similar number of punctures (1 to 3 times), CEUS improved diagnostic accuracy when compared to that of the conventional US (100%, 75%; P=0.486). The technical success rate was 100% (68/68). In both groups, patients did not exhibit symptomatic complications such as bleeding, pneumothorax, or hemoptysis after the biopsy.
The application of CEUS in transthoracic biopsy of malignant AMMs improved diagnostic accuracy when compared with conventional US and especially played more important role in lesions exceeding 10 cm and presumptive clinical carcinoma.
鉴于前纵隔肿块（AMM）发病率低且异质性高，基于病理的治疗策略多样。本研究旨在评估与单纯超声（US）相比，对比增强超声（CEUS）在恶性AMM经胸活检中的有效性，并筛选更适合CEUS评估和引导的病变。
我们回顾了2013年7月至2019年4月在中国医学科学院肿瘤医院/国家癌症中心/国家癌症临床研究中心进行的所有US和CEUS引导下的AMM经胸芯针活检（CNB）。共有68例疑似恶性AMM的患者（平均年龄36岁；男女比例1.6:1）纳入本研究。其中，20例患者在活检前接受了CEUS检查（CEUS组）；48例患者接受了传统US检查及引导（US组）。对两组患者的人口统计学、影像学、病理学、病历及活检操作细节进行回顾性分析并比较。
与传统US相比，CEUS对内部坏死区域的显示有显著改善（70%对30%；P = 0.008）。具体而言，CEUS提高了US引导下经胸活检的诊断准确性（95.0%对79.2%；P = 0.210），尤其是对于直径超过10 cm的AMM（100%对68.2%；P = 0.040）和癌（100%对0%；P = 0.048）。US组和CEUS组的穿刺次数分别为2.6次和4.4次（P < 0.001）。在穿刺次数相近（1至3次）的情况下，与传统US相比，CEUS提高了诊断准确性（100%对75%；P = 0.486）。技术成功率为100%（68/68）。两组患者活检后均未出现出血、气胸或咯血等有症状的并发症。
与传统US相比，CEUS在恶性AMM经胸活检中的应用提高了诊断准确性，尤其在直径超过10 cm的病变和临床疑似癌中发挥了更重要的作用。
