Zhang Ying-Lun, Ma Qian, Hu Yu, Wu Meng-Jie, Wei Zong-Kai, Yao Qi-Yu, Li Ju-Ming, Li Ao
Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, Gulou district, China.
Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, Gulou district, China.
Res Diagn Interv Imaging. 2023 Jan 13;5:100023. doi: 10.1016/j.redii.2023.100023. eCollection 2023 Mar.
To evaluate the diagnostic yield of ultrasonography (US)-guided core needle biopsy (CNB) in the diagnosis of soft tissue tumors (STTs) and to analyze the failure factors.
139 patients with STTs that underwent both US-guided CNB and surgical resection were collected retrospectively. Compared with the histopathological results of surgical resection, the biopsy failure was defined as the following conditions: indefinitive diagnosis, including insufficient samples and unknown subtypes with correct biological potential classification; wrong diagnosis, including wrong biological potential classification and wrong subtypes with correct biological potential classification. Univariate and multivariate analyses from the perspectives of histopathological, demographic and US features together with biopsy procedures were performed to determine risk factors for diagnostic failure.
The diagnostic yield of US-guided CNB for STTs in our study was 78.4%, but when only considering the correct biological potential classification of STTs, the diagnostic yield was 80.6%. The multivariate analysis showed that adipocytic tumors (odds ratio (OR) = 10.195, 95% confidence interval (CI): 1.062 - 97.861, = 0.044), vascular tumors (OR = 41.710, 95% CI: 3.126 - 556.581, = 0.005) and indeterminate US diagnosis (OR = 8.641, 95% CI: 1.852 - 40.303, = 0.006) were correlated with the diagnostic failure. The grade III vascular density (OR = 0.019, 95% CI: 0.001 - 0.273, = 0.007) enabled a higher diagnostic accuracy.
US-guided CNB can be an effective modality for the diagnosis of STTs. The diagnostic yield can be increased when the tumor vascular density was grade III in Color Doppler US, but can be decreased in adipocytic tumors, vascular tumors and masses with indeterminate US diagnosis.
评估超声（US）引导下的粗针穿刺活检（CNB）对软组织肿瘤（STT）的诊断效能，并分析失败因素。
回顾性收集139例接受US引导下CNB及手术切除的STT患者。将活检失败定义为与手术切除的组织病理学结果相比出现以下情况：诊断不明确，包括样本不足及生物学潜能分类正确但亚型不明；诊断错误，包括生物学潜能分类错误及生物学潜能分类正确但亚型错误。从组织病理学、人口统计学和US特征以及活检操作等角度进行单因素和多因素分析，以确定诊断失败的危险因素。
在本研究中，US引导下CNB对STT的诊断效能为78.4%，但仅考虑STT正确的生物学潜能分类时，诊断效能为80.6%。多因素分析显示，脂肪细胞性肿瘤（比值比（OR）=10.195，95%置信区间（CI）：1.062 - 97.861，P = 0.044）、血管性肿瘤（OR = 41.710，95% CI：3.126 - 556.581，P = 0.005）及US诊断不明确（OR = 8.641，95% CI：1.852 - 40.303，P = 0.006）与诊断失败相关。III级血管密度（OR = 0.019，95% CI：0.001 - 0.273，P = 0.007）可提高诊断准确性。
US引导下CNB可为STT的诊断提供一种有效的方法。当彩色多普勒US显示肿瘤血管密度为III级时，诊断效能可提高，但脂肪细胞性肿瘤、血管性肿瘤及US诊断不明确的肿块的诊断效能会降低。
