Department of Clinical Radiology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan.
Diagn Interv Radiol. 2023 Nov 7;29(6):800-804. doi: 10.4274/dir.2022.221152. Epub 2022 Dec 12.
To retrospectively determine the diagnostic accuracy of a percutaneous core biopsy performed before cryoablation for small-sized renal cell carcinoma.
In this study, 216 patients underwent a percutaneous core biopsy for 242 renal lesions suspected to be renal cell carcinoma on image findings before cryoablation at Kyushu University Hospital. We calculated the success rate of the histological diagnosis and investigated factors that may have contributed to the diagnostic success. Complications caused by the biopsy procedure were also evaluated.
The histological diagnosis was successful in 203 lesions (82.8%). The success rate of the histological diagnosis was 65.4% (34/52 cases) for tumors with a diameter of ≤15 mm and 88.9% (169/190 cases) for those >15 mm. Therefore, tumor diameter was a factor contributing to the histological diagnosis success rate in both univariate and multivariable analyses ( < 0.001). For lesions with a tumor diameter ≤15 mm, the histological diagnosis success rates increased from 50.0% to 76.2% in the presence of pre-lipiodol marking and to 85.7% when the biopsy procedure was performed separately from cryoablation; the latter was statistically significant ( = 0.039). Major complications that may have been caused by the biopsy procedure were grade 3 bleeding and tract seeding (one case each).
Percutaneous core biopsy in cryoablation for small-sized renal cell carcinoma had a high diagnostic rate and was safely performed. For lesions with a tumor diameter ≤15 mm, a separate biopsy procedure and pre-lipiodol marking may improve the diagnostic accuracy.
回顾性分析小肾癌行冷冻消融术前经皮穿刺活检的诊断准确性。
本研究共纳入 216 例在九州大学医院因影像学表现怀疑为肾癌而行冷冻消融术前接受经皮穿刺活检的 242 个肾脏病灶的患者。我们计算了组织学诊断的成功率，并探讨了可能有助于诊断成功的因素。还评估了活检过程引起的并发症。
203 个病灶（82.8%）的组织学诊断成功。直径≤15mm 的肿瘤的组织学诊断成功率为 65.4%（34/52 例），直径>15mm 的肿瘤的成功率为 88.9%（169/190 例）。因此，肿瘤直径是单因素和多因素分析中组织学诊断成功率的一个因素（<0.001）。对于直径≤15mm 的病灶，在预碘化油标记存在的情况下，组织学诊断成功率从 50.0%增加到 76.2%，当活检程序与冷冻消融分开进行时，成功率增加到 85.7%；后者具有统计学意义（=0.039）。可能由活检程序引起的主要并发症为 3 级出血和种植转移（各 1 例）。
冷冻消融术治疗小肾癌的经皮穿刺活检具有较高的诊断率且安全。对于直径≤15mm 的病灶，单独进行活检程序和预碘化油标记可能会提高诊断准确性。
