Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., San Francisco, CA, 94143, USA.
Abdom Radiol (NY). 2022 Aug;47(8):2640-2646. doi: 10.1007/s00261-022-03494-5. Epub 2022 Apr 9.
To determine the prevalence of adverse events after image-guided biopsy of histologically proven hepatocellular carcinomas (HCC) using a standardized, indirect access, coaxial biopsy technique.
In this IRB-approved, HIPAA compliant, and retrospective study, we evaluated all consecutive adult patients from 2011 to 2016 who underwent image-guided biopsy of HCC with and without concurrent ablation. Tumor seeding was defined as any new lesion along the needle tract on subsequent imaging. Adverse events were graded using both the Clavien-Dindo Complication Classification system and the most recently proposed Society of Interventional Radiology (SIR) Adverse Event Classification System.
A total of 383 patients underwent 398 biopsies (64 ± 11 years; 112 women, 271 men). Most patients (282; 71%) underwent concurrent ablation. Adverse events occurred after 18 biopsies (4.5%): 13 were Grade I (Clavien-Dindo) or minor (SIR) and included hematoma (7), hepatic vein thrombus (2), portal vein thrombus (2), moderate pleural effusion (1), and small pneumothorax (1). The remaining 5 (1.3%) adverse events were classified as Grade II-IIIa (Clavien-Dindo) or moderate (SIR) and included hematoma requiring blood products (n = 1), arrhythmia (n = 1), and symptomatic pleural effusions requiring treatment (n = 3). Baseline age, sex, cause of liver disease, HCC diameter, and HCC grade were not associated with adverse events. There were no tumor seeding events after a median follow-up of 611 days (interquartile range of 211-1104).
Percutaneous image-guided tissue sampling using a standardized, indirect access, coaxial technique can be performed safely with and without concurrent ablation by trained cross-sectional interventional radiologists at a tertiary liver transplant center.
采用标准化的间接进入同轴活检技术，确定组织学证实的肝细胞癌（HCC）影像引导活检后的不良事件发生率。
本研究为经机构审查委员会批准、符合 HIPAA 规定和回顾性研究，我们评估了 2011 年至 2016 年间所有连续接受 HCC 影像引导活检且同时接受消融治疗或单纯活检的成年患者。肿瘤种植定义为在后续影像学检查中沿针道出现的任何新病变。采用 Clavien-Dindo 并发症分类系统和最近提出的介入放射学学会（SIR）不良事件分类系统对不良事件进行分级。
共 383 例患者接受了 398 次活检（64±11 岁；112 例女性，271 例男性）。大多数患者（282 例，71%）同时接受了消融治疗。18 例（4.5%）发生了不良事件：13 例为 Clavien-Dindo Ⅰ级或轻微（SIR），包括血肿（7 例）、肝静脉血栓形成（2 例）、门静脉血栓形成（2 例）、中等量胸腔积液（1 例）和少量气胸（1 例）。其余 5 例（1.3%）不良事件为 Clavien-Dindo Ⅱ-Ⅲa 级或中度（SIR），包括需要输血的血肿（1 例）、心律失常（1 例）和需要治疗的症状性胸腔积液（3 例）。基线年龄、性别、肝病病因、HCC 直径和 HCC 分级与不良事件无关。中位随访 611 天（211-1104 天）后未发生肿瘤种植事件。
在三级肝移植中心，经过培训的横断面介入放射科医生采用标准化的间接进入同轴技术进行经皮影像引导组织取样，无论是否同时进行消融治疗，都可以安全进行。
