Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Centre, Leipzig, Germany.
Division of Interdisciplinary Ultrasound, Department of Internal Medicine I (Gastroenterology, Pneumology), University Hospital Halle, Halle (Saale), Germany.
PLoS One. 2024 May 22;19(5):e0304026. doi: 10.1371/journal.pone.0304026. eCollection 2024.
Ultrasound-guided biopsy of focal liver lesions (FLL) is a well-established procedure with crucial impact on therapeutic decisions. The safety and accuracy depend on needle type, tumour location and comorbidities. Modern oncological concepts often require large tumour specimens which may increase the procedural risk.
We retrospectively collected data from consecutively scheduled ultrasound-guided FLL biopsies performed in an interdisciplinary ultrasound unit at a university hospital from 2015-2020. We analysed complication rates, diagnostic accuracy, and patient outcome in a one-year period.
Of 426 scheduled interventions, 339 were included: 322 primary biopsies (40% female, median age 65 years, median BMI 25.4 kg/m2) and 17 rebiopsies in cases with undetermined diagnosis. Indications comprised 309 (96%) cases with suspected malignant lesions. Important comorbidities were type 2 diabetes (n = 107, 33%) and cirrhosis (n = 64, 20%). A conclusive histopathological diagnosis was achieved in 270 (84%) cases with a weak association with lesion size (OR 1.12 per cm, 95%CI 0.99-1.27). Greater BMI (OR 0.60 per 10 BMI points, 95%CI 0.34-1.05) showed a trend towards an insufficient diagnosis. Relevant complications occurred in 8 (2.5%) cases (2 major; 1 life-threatening). Multiple passes showed a trend towards adverse events (OR 2.32 for > 1 pass, 95%CI 0.99-5.42). 93 (29%) patients died during a median follow-up of 171 days.
Ultrasound-guided FLL biopsy is an efficient and safe diagnostic measure. The limitations of the procedure and its associated risks should be considered in patients with advanced malignancies.
超声引导下肝脏局灶性病变（FLL）活检是一种成熟的技术，对治疗决策具有重要影响。其安全性和准确性取决于针的类型、肿瘤位置和合并症。现代肿瘤学概念通常需要大的肿瘤标本，这可能会增加操作风险。
我们回顾性地收集了 2015 年至 2020 年在一所大学医院的一个多学科超声单位进行的连续安排的超声引导下 FLL 活检的数据。我们在一年的时间内分析了并发症发生率、诊断准确性和患者结果。
在 426 次预定的干预中，有 339 次被纳入：322 例原发性活检（40%为女性，中位年龄 65 岁，中位 BMI 为 25.4kg/m2）和 17 例在诊断不明确的情况下进行的重复活检。适应证包括 309 例（96%）疑似恶性病变的病例。重要的合并症有 2 型糖尿病（n=107，33%）和肝硬化（n=64，20%）。270 例（84%）病例获得明确的组织病理学诊断，与病变大小呈弱相关（每增加 1cm 的 OR 为 1.12，95%CI 为 0.99-1.27）。较大的 BMI（每增加 10 个 BMI 点的 OR 为 0.60，95%CI 为 0.34-1.05）显示出诊断不足的趋势。8 例（2.5%）出现相关并发症（2 例严重；1 例危及生命）。多次活检显示出不良事件的趋势（OR 为 2.32，大于 1 次的 OR，95%CI 为 0.99-5.42）。在中位随访 171 天期间，93 例（29%）患者死亡。
超声引导下 FLL 活检是一种有效和安全的诊断措施。在晚期恶性肿瘤患者中，应考虑该操作的局限性及其相关风险。
