Buonomo Francesca, Bussolaro Sofia, de Almeida Fiorillo Clarice, Oliveira de Souza Danilo, Giudici Fabiola, Romano Federico, Romano Andrea, Ricci Giuseppe
Institute for Maternal and Child Health, I.R.C.C.S. "Burlo Garofolo", 34137 Trieste, Italy.
Department of Medical, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy.
J Clin Med. 2022 Apr 30;11(9):2534. doi: 10.3390/jcm11092534.
The aim of this study was to evaluate the feasibility of adequacy, accuracy, and safety of ultrasound-guided tru-cut biopsy in managing malignant and benign abdominopelvic masses in a selected population and critically discuss some issues in different situations, which deserve some reflections on those practices.
This is a retrospective study involving 42 patients who underwent transvaginal or transabdominal tru-cut biopsy between August 2017 and November 2021. The inclusion criteria were poor health status or primary inoperable advanced tumor, suspicion of recurrence or metastasis to the ovaries or peritoneum in gynecological and non-gynecological pelvic malignancies. Tissue samples were considered adequate if it was possible to determine the origin of the tumor, and immunohistochemistry could be performed. Diagnostic accuracy was assessed considering the agreement between tru-cut biopsy histology and final postoperative histology.
It total, 44 biopsies were obtained from 42 patients (2 patients had repeat biopsies). The pathologist considered all pathological samples adequate (adequacy 100%). The final histology was consistent with tru-cut biopsy diagnosis in all but 2 cases (diagnostic accuracy 88.2%). If we consider only the cases that have carried out at least two diagnostic samples, accuracy rose to 94.1%. Pathological examinations from tru-cut samples showed 2 benign lesions (4.8%) and 40 malignant tumors (95.2%), divided into 19 advanced primary inoperable ovarian cancers, 7 primary advanced cervical cancers, 4 recurrent endometrial cancers, 3 recurrent cervical cancers, 3 recurrent ovarian cancers, 1 case of primitive peritoneal malignancy (leiomyosarcoma), and 3 non-gynecological cancers with a strong suspicion of metastases at ultrasound (2 cases of ovarian, colorectal cancer metastasis, and 1 case of pelvic site type B lymphoma metastasis). However, one case of minor complication related to the procedure was reported but not significant.
The diagnostic adequacy, accuracy of the tru-cut biopsy, and safety were high. Pathological samples are representative of the disease and suitable for histological and immunohistochemical analysis.
本研究旨在评估超声引导下切割活检在特定人群中处理恶性和良性腹盆腔肿块的充分性、准确性及安全性的可行性，并批判性地讨论不同情况下的一些问题，这些问题值得对这些实践进行反思。
这是一项回顾性研究，纳入了2017年8月至2021年11月期间接受经阴道或经腹切割活检的42例患者。纳入标准为健康状况差或原发性无法手术的晚期肿瘤、怀疑妇科和非妇科盆腔恶性肿瘤复发或转移至卵巢或腹膜。如果能够确定肿瘤起源且可进行免疫组化检查，则认为组织样本是充分的。通过比较切割活检组织学与最终术后组织学的一致性来评估诊断准确性。
42例患者共进行了44次活检（2例患者进行了重复活检）。病理学家认为所有病理样本均充分（充分率100%）。除2例病例外，最终组织学与切割活检诊断一致（诊断准确性88.2%）。如果仅考虑至少进行了两次诊断性样本的病例，准确性升至94.1%。切割样本的病理检查显示2例良性病变（4.8%）和40例恶性肿瘤（95.2%），其中包括19例原发性无法手术的晚期卵巢癌、7例原发性晚期宫颈癌、4例复发性子宫内膜癌、3例复发性宫颈癌、3例复发性卵巢癌、1例原发性腹膜恶性肿瘤（平滑肌肉瘤）以及3例超声高度怀疑转移的非妇科癌症（2例卵巢、结直肠癌转移，1例盆腔B型淋巴瘤转移）。然而，报告了1例与该操作相关的轻微并发症，但不严重。
切割活检的诊断充分性、准确性及安全性较高。病理样本具有疾病代表性，适用于组织学和免疫组化分析。
