Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Department of Radiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada.
J Vasc Interv Radiol. 2022 Feb;33(2):159-168.e1. doi: 10.1016/j.jvir.2021.11.001. Epub 2021 Nov 12.
To assess the impact of radiology review for discordance between pathology results from computed tomography (CT)-guided biopsies versus imaging findings performed before a biopsy.
In this retrospective review, which is compliant with the Health Insurance Portability and Accountability Act and approved by the institutional review board, 926 consecutive CT-guided biopsies performed between January 2015 and December 2017 were included. In total, 453 patients were presented in radiology review meetings (prospective group), and the results were classified as concordant or discordant. Results from the remaining 473 patients not presented at the radiology review meetings were retrospectively classified. Times to reintervention and to definitive diagnosis were obtained for discordant cases; of these, 49 (11%) of the 453 patients were in the prospective group and 55 (12%) of the 473 patients in the retrospective group.
Pathology results from CT-guided biopsies were discordant with imaging in 11% (104/926) of the cases, with 57% (59/104) of these cases proving to be malignant. In discordant cases, reintervention with biopsy and surgery yielded a shorter time to definitive diagnosis (28 and 14 days, respectively) than an imaging follow-up (78 days) (P < .001). The median time to diagnosis was 41 days in the prospective group and 56 days in the retrospective group (P = .46). When radiologists evaluated the concordance between pathology and imaging findings and recommended a repeat biopsy for the discordant cases, more biopsies were performed (50% [11/22] vs 13% [4/31]; P = .005).
Eleven percent of CT-guided biopsies yielded pathology results that were discordant with imaging findings, with 57% of these proving to be malignant on further workup.
评估影像学复查对 CT 引导活检的病理结果与活检前影像学表现不一致的影响。
本研究回顾性分析了 2015 年 1 月至 2017 年 12 月期间进行的 926 例连续 CT 引导活检，符合《健康保险携带和责任法案》并经机构审查委员会批准。共有 453 例患者在影像学复查会议中展示（前瞻性组），结果分为一致或不一致。对未在影像学复查会议中展示的其余 473 例患者的结果进行回顾性分类。对不一致病例的再次干预和明确诊断时间进行了记录；其中，453 例前瞻性组患者中有 49 例（11%）、473 例回顾性组患者中有 55 例（12%）为不一致病例。
CT 引导活检的病理结果与影像学表现不一致的病例占 11%（104/926），其中 57%（59/104）为恶性。在不一致病例中，再次活检和手术的明确诊断时间更短（分别为 28 天和 14 天），而影像学随访的明确诊断时间更长（78 天）（P<0.001）。前瞻性组的中位诊断时间为 41 天，回顾性组为 56 天（P=0.46）。当放射科医生评估病理与影像学表现的一致性并建议对不一致病例进行重复活检时，进行了更多的活检（50%[11/22]与 13%[4/31]；P=0.005）。
11%的 CT 引导活检的病理结果与影像学表现不一致，进一步检查证实其中 57%为恶性。
