Daggett Sarah M, Pickhardt Perry J, Elissa Matthew, Richards Elizabeth S, Zea Ryan, Lubner Meghan G
University of Wisconsin School of Medicine and Public Health, Madison, USA.
Abdom Radiol (NY). 2024 Dec 27. doi: 10.1007/s00261-024-04706-w.
To evaluate the diagnostic yield and safety profile of percutaneous image-guided biopsy of mesenteric lesions.
MATERIALS, METHODS, AND PROCEDURES: Image-guided percutaneous biopsies of the mesentery at a single institution from 2000 to 2022 were identified and reviewed. Relevant demographic and procedural data were abstracted from the medical record. Surgical pathology was reviewed to evaluate if the biopsy was diagnostic and concordant with the patient's final diagnosis.
One hundred ninety five patients (mean age, 62.6 ± 14.; M/F, 113/82; mean BMI, 30.4) underwent mesenteric biopsy procedure. Of these, 173 (89%) were performed using ultrasound and 22 (11%) were performed using CT or a hybrid/combined approach. Core needle biopsy was used in 164 (84%) patients, fine-needle aspiration (FNA) was used in 21 (11%), and both were used 10 (5%). Mean/median number of biopsy passes was 2.8 ± 1.3 and 3, respectively (core mean 2.7 ± 1.2; FNA mean 3.4 ± 1.5). Average lesion size was 5.3 ± 4.4 cm in the long axis and 2.9 ± 2.0 cm in the target plane. Diagnostic yield of core biopsies was 97.7% (n = 170/174) and FNA was 80.6% (n = 25/31) for an overall combined yield of 96.4% (n = 188/195). Of diagnostic biopsies, 95.7% (n = 180/188) were concordant with the final diagnosis, 70.8% (n = 138) of which were considered malignant. Overall concordant diagnostic rate was 180/195 (92.3%). Neuroendocrine tumor pathology was the only factor associated with lower diagnostic yield (13/15, 87%). For all biopsies, average shortest skin-to-target-distance on CT was 6.3 ± 2.8 cm, decreased to 4.1 ± 1.3 cm with US compression (approximately 35% reduction, p < 0.001). Additionally, ultrasound created a safe path not available on CT in 29 (15%) biopsies. Moderate IV sedation was used in 91.3% (n = 178) of mesenteric procedures. Complications occurred in 11 (5.6%) biopsies, and all were considered minor.
This represents a large cohort of image-guided percutaneous biopsies of mesenteric lesions with the majority representing core biopsy performed under US guidance. This technique offers high diagnostic yield and a favorable safety profile for tissue diagnosis. Furthermore, compression with ultrasound reduced skin-to-target distance by 35% and created a biopsy path that would not be possible on CT in 15% of US cases.
评估经皮影像引导下肠系膜病变活检的诊断率及安全性。
材料、方法与步骤：对2000年至2022年在单一机构进行的影像引导下经皮肠系膜活检进行识别和回顾。从病历中提取相关人口统计学和操作数据。回顾手术病理结果，以评估活检是否具有诊断价值以及是否与患者的最终诊断一致。
195例患者（平均年龄62.6±14岁；男/女比例为113/82；平均体重指数30.4）接受了肠系膜活检。其中，173例（89%）采用超声引导，22例（11%）采用CT引导或混合/联合引导方法。164例（84%）患者采用粗针活检，21例（11%）采用细针穿刺抽吸活检（FNA），10例（5%）两种方法均采用。活检穿刺次数的均值/中位数分别为2.8±1.3次和3次（粗针活检均值2.7±1.2次；FNA均值3.4±1.5次）。病变平均长径为5.3±4.4cm，靶平面平均直径为2.9±2.0cm。粗针活检的诊断率为97.7%（n = 170/174），FNA的诊断率为80.6%（n = 25/31），总体联合诊断率为96.4%（n = 188/195）。在诊断性活检中，95.7%（n = 180/188）与最终诊断一致，其中70.8%（n = 138）被认为是恶性的。总体一致诊断率为180/195（92.3%）。神经内分泌肿瘤病理是与较低诊断率相关的唯一因素（13/15，87%）。对于所有活检，CT上平均最短皮肤至靶距离为6.3±2.8cm，超声压迫后降至4.1±1.3cm（约减少35%，p < 0.001）。此外？在29例（15%）活检中，超声创造了CT引导下无法获得的安全路径。91.3%（n = 178）的肠系膜活检操作使用了中度静脉镇静。11例（5.6%）活检发生并发症，均为轻微并发症。
这是一大组经皮影像引导下的肠系膜病变活检病例，大多数为超声引导下的粗针活检。该技术对组织诊断具有较高的诊断率和良好的安全性。此外，超声压迫使皮肤至靶距离减少了35%，并在15%的超声引导病例中创造了CT引导下无法实现的活检路径。
