Pitot Marika A, Gu Chris N, Adamo Daniel A, Kurup Anil Nicholas, Schmitz John J, Packard Annie T
Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Abdom Radiol (NY). 2023 Jun;48(6):2148-2156. doi: 10.1007/s00261-023-03867-4. Epub 2023 Mar 20.
The purpose of this study was to determine the safety and accuracy of aortic and periaortic computed tomography (CT)-guided percutaneous core needle biopsy performed at a single center over 12 years.
A retrospective review was conducted of cases performed between February 2010 and August 2022 in which the biopsied region was in direct contact with the aorta or great vessels including the pericardium and common iliac arteries. Clinical notes were reviewed for any early or delayed complications following the procedure, which if present were graded using the National Institute of Health's Common Terminology Criteria for Adverse Events, version 5.0. Pathology results were compared to subsequent outside biopsy results or follow-up surgical pathology, if available, as well as subsequent clinical decision making and/or clinical course, to determine concordance. Sensitivity, specificity, predictive value, and accuracy (indicative of diagnostic yield) were calculated.
32 core needle biopsies were reviewed from 30 patients (average lesion longest diameter 3.1 cm, range 0.5-10.9 cm; average needle proximity to the vessel endothelium or deep side of the pericardium 1.0 cm, range 0.3-1.8 cm). Complications occurred in 46.9% of cases (15/32), 93.3% (14/15) of which were minor and included small amounts of bleeding or pain. One patient developed a small nonemergent pneumothorax. Of biopsies obtained, 96.9% provided adequate tissue for diagnosis (31/32). When evaluating concordance between pathological and final diagnosis, sensitivity was 94.7% and specificity was 83.3%; positive and negative predictive value were 90.0% and 90.9%, respectively. Accuracy (diagnostic yield) of biopsy was 90.3%.
CT-guided percutaneous aortic and periaortic core needle biopsies are safe and efficacious procedures with high diagnostic yield.
本研究旨在确定在一个中心12年间进行的主动脉及主动脉周围计算机断层扫描（CT）引导下经皮芯针活检的安全性和准确性。
对2010年2月至2022年8月期间进行的病例进行回顾性研究，其中活检区域与主动脉或大血管（包括心包和髂总动脉）直接接触。查阅临床记录，了解术后任何早期或延迟并发症，如有并发症，则使用美国国立卫生研究院不良事件通用术语标准第5.0版进行分级。将病理结果与后续外部活检结果或随访手术病理结果（如可用）以及后续临床决策和/或临床病程进行比较，以确定一致性。计算敏感性、特异性、预测值和准确性（指示诊断率）。
回顾了30例患者的32次芯针活检（平均病变最长直径3.1cm，范围0.5 - 10.9cm；平均针与血管内皮或心包深侧的距离为1.0cm，范围0.3 - 1.8cm）。46.9%的病例（15/32）发生并发症，其中93.3%（14/15）为轻微并发症，包括少量出血或疼痛。1例患者出现小型非紧急气胸。在获取的活检样本中，96.9%提供了足够的组织用于诊断（31/32）。在评估病理诊断与最终诊断的一致性时，敏感性为94.7%，特异性为83.3%；阳性和阴性预测值分别为90.0%和90.9%。活检的准确性（诊断率）为90.3%。
CT引导下经皮主动脉及主动脉周围芯针活检是安全有效的检查方法，诊断率高。
