Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA.
Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, USA.
Abdom Radiol (NY). 2022 Aug;47(8):2647-2657. doi: 10.1007/s00261-021-03278-3. Epub 2021 Oct 23.
To evaluate the efficacy of percutaneous biopsy for diagnosing intrahepatic cholangiocarcinoma (IHCCA).
Retrospective review of biopsy and pathology databases from 2006 to 2019 yielded 112 patients (54F/58 M; mean age, 62.9 years; 27 cirrhotic) with IHCCA who underwent percutaneous biopsy. Data regarding the lesion, biopsy procedure technique, and diagnostic yield were collected. If biopsy was non-diagnostic or discordant with imaging, details of repeat biopsy or resection/explant were gathered. A control group of 100 consecutive patients (56F/44 M; mean age, 63 years, 5 cirrhotic) with focal liver lesions > 1 cm was similarly assessed.
Mean IHCCA lesion size was 6.1 ± 3.6 cm, with dominant lesion sampled in 78% (vs. satellite in 22%). 95% (n = 106) were US guided and 96% were core biopsies (n = 108), typically 18G (n = 102, 91%), median 2 passes. 18 patients (16%) had discordant/ambiguous pathology results requiring repeat biopsy, with two patients requiring 3-4 total attempts. A 4.4% minor complication rate was seen. Mean time from initial biopsy to final diagnosis was 60 ± 120 days. Control group had mean lesion size of 2.9 ± 2.5 cm and showed a non-diagnostic rate of 3.3%, both significantly lower than that seen with CCA, with average time to diagnosis of 21 ± 28.8 days (p = 0.002, p = 0.001).
IHCCA is associated with lower diagnostic yield at initial percutaneous biopsy, despite larger target lesion size. If a suspicious lesion yields a biopsy result discordant with imaging, the radiologist should recommend prompt repeat biopsy to prevent delay in diagnosis.
评估经皮活检诊断肝内胆管癌（IHCCA）的疗效。
回顾 2006 年至 2019 年活检和病理数据库，共纳入 112 例接受经皮活检的 IHCCA 患者（54 例女性/58 例男性；平均年龄 62.9 岁；27 例肝硬化）。收集有关病变、活检程序技术和诊断率的数据。如果活检结果为非诊断性或与影像学结果不一致，则收集重复活检或切除/移植的详细信息。还对 100 例连续的局灶性肝病变＞1cm 的患者（56 例女性/44 例男性；平均年龄 63 岁，5 例肝硬化）进行了类似评估。
IHCCA 病变的平均大小为 6.1±3.6cm，78%（22%为卫星病变）的主导病变被取样。95%（n=106）为超声引导，96%（n=108）为核心活检，通常使用 18G（n=102，91%），中位数为 2 次穿刺。18 例（16%）患者的病理结果存在不一致/模棱两可，需要重复活检，其中 2 例患者需要进行 3-4 次活检。有 4.4%的轻微并发症发生率。从初次活检到最终诊断的平均时间为 60±120 天。对照组的病变平均大小为 2.9±2.5cm，非诊断率为 3.3%，均显著低于 CCA，平均诊断时间为 21±28.8 天（p=0.002，p=0.001）。
尽管 IHCCA 的目标病变较大，但初次经皮活检的诊断率较低。如果可疑病变的活检结果与影像学结果不一致，放射科医生应建议及时重复活检，以避免诊断延误。
