Royal National Orthopaedic Hospital, London, UK.
Skeletal Radiol. 2020 Jul;49(7):1115-1125. doi: 10.1007/s00256-020-03406-y. Epub 2020 Mar 9.
To determine the reliability of image-guided core needle biopsy (IGCNB) for the diagnosis and grading of chondral tumours of bone compared with surgical histology.
Retrospective review of patients with a chondral tumour of bone who underwent IGCNB and surgical resection between January 2007 and December 2017. Data collected included age, sex, skeletal location, technique used for IGCNB, IGCNB result including histological grade and comparison with surgical histology.
A total of 237 patients were included (135 males and 102 females with mean age 53.7 years, range 9-89 years). A total of 174 IGCNBs were CT-guided, 57 ultrasound-guided and 6 fluoroscopic-guided. Two hundred thirty-six of 237 (99.6%) IGCNBs were diagnostic for a chondral tumour, although grade could not be determined in 13 (5.5%) due to necrosis. A positive correlation for tumour grade between IGCNB and surgical histology was achieved in 181 cases (76.4%). In 36 patients (15.2%), IGCNB under-graded the tumour, while in 6 (2.5%), IGCNB over-graded the tumour. Discrepancy between IGCNB and surgical histology was significantly greater for surface/peripheral lesions (p = 0.02) and lesions arising from the flat bones or spine (p = 0.002).
IGCNB can achieve a diagnosis of a chondral tumour in a high proportion of cases when compared with final diagnosis from surgical resection specimens. However, correlation of tumour grade between IGCNB and resection histology is less reliable with discordance seen in almost one-quarter of cases, most commonly at non-appendicular sites. Therefore, IGCNB results should not be considered in isolation of imaging and clinical features when planning surgical management.
与手术组织学相比，确定图像引导下核心针活检（IGCNB）在骨软骨肿瘤的诊断和分级中的可靠性。
回顾性分析 2007 年 1 月至 2017 年 12 月期间接受 IGCNB 和手术切除的骨软骨肿瘤患者。收集的数据包括年龄、性别、骨骼位置、IGCNB 技术、IGCNB 结果（包括组织学分级）以及与手术组织学的比较。
共纳入 237 例患者（男 135 例，女 102 例，平均年龄 53.7 岁，范围 9-89 岁）。237 例患者中，174 例行 CT 引导 IGCNB，57 例行超声引导 IGCNB，6 例行透视引导 IGCNB。237 例 IGCNB 中，236 例（99.6%）为软骨肿瘤的诊断性活检，13 例（5.5%）因坏死无法确定肿瘤分级。181 例（76.4%）IGCNB 和手术组织学肿瘤分级呈正相关。在 36 例（15.2%）患者中，IGCNB 低估了肿瘤分级，而在 6 例（2.5%）患者中，IGCNB 高估了肿瘤分级。IGCNB 与手术组织学的差异在表面/周围病变（p=0.02）和起源于扁平骨或脊柱的病变（p=0.002）中更为显著。
与手术切除标本的最终诊断相比，IGCNB 可以在很大比例的病例中诊断软骨肿瘤。然而，IGCNB 与切除组织学肿瘤分级的相关性不太可靠，约四分之一的病例存在差异，最常见于非附肢部位。因此，在规划手术治疗时，不应孤立地考虑 IGCNB 结果，还应考虑影像学和临床特征。
