Niceforo J, Coughlin B F
Department of Radiology, Baystate Medical Center, Springfield, MA 01199.
AJR Am J Roentgenol. 1993 Dec;161(6):1303-5. doi: 10.2214/ajr.161.6.8249747.
A retrospective study of imaging-directed percutaneous fine-needle aspiration cytology of focal renal lesions was performed. The objectives were to determine the efficacy and safety of renal aspiration biopsy in establishing the diagnosis of renal cell carcinoma and avoiding nephrectomy in patients with a renal mass and disseminated metastases or with a renal mass and relative contraindications to nephrectomy.
Between September 1987 and September 1991, 55 consecutive patients had 57 imaging-directed renal aspiration biopsies at our institution. We examined the medical records, pathology reports, imaging studies, and follow-up information of the 23 patients who had the procedure because of disseminated metastases (10 patients) or relative contraindications to nephrectomy (13 patients). Preliminary diagnoses were based on the cytopathology, and final diagnoses were based on the surgical pathology (six patients) or clinical course over more than 6 months (17 patients).
Cytopathologic findings were true-positive in 12 patients, true-negative in eight, false-negative in three, and false-positive in none. The sensitivity was 80%, the specificity was 100%, and the accuracy was 87%. Of the 10 patients with a renal mass and disseminated metastases, aspiration cytology failed to show malignancy in only one. None of these patients had surgery, and all died within 1 year. Of the 13 patients with relative contraindications to surgery, seven were treated without surgery. The cytologic diagnosis was renal cell carcinoma in two of the seven, and these two patients have since died. Cytopathology was negative for renal cell carcinoma in five of the seven, and subsequent imaging studies in these patients have shown no renal mass enlargement or metastases 2-3 years after biopsy (three patients) or the patients have died of severe heart disease (two patients). Nephrectomy was performed in the remaining six patients, and no evidence of disease had been found 2-4 years after removal of two oncocytomas and four renal cell carcinomas. There were no significant complications.
Percutaneous renal aspiration biopsy cytology is accurate, safe, and useful in establishing the diagnosis of renal cell carcinoma in patients with disseminated metastases or relative contraindications to surgery.
对影像学引导下局灶性肾病变经皮细针穿刺抽吸细胞学检查进行回顾性研究。目的是确定肾穿刺活检在诊断肾细胞癌以及避免对有肾肿块且伴有播散性转移或有肾肿块且存在肾切除相对禁忌证的患者进行肾切除术方面的有效性和安全性。
1987年9月至1991年9月期间，在我们机构有55例连续患者接受了57次影像学引导下的肾穿刺活检。我们检查了因播散性转移（10例患者）或肾切除相对禁忌证（13例患者）而接受该操作的23例患者的病历、病理报告、影像学检查及随访信息。初步诊断基于细胞病理学，最终诊断基于手术病理学（6例患者）或超过6个月的临床病程（17例患者）。
细胞病理学检查结果为真阳性12例，真阴性8例，假阴性3例，无假阳性。敏感性为80%，特异性为100%，准确性为87%。在10例有肾肿块且伴有播散性转移的患者中，穿刺细胞学检查仅1例未显示恶性肿瘤。这些患者均未接受手术，全部在1年内死亡。在13例有手术相对禁忌证的患者中，7例未接受手术治疗。这7例中有2例细胞诊断为肾细胞癌，这2例患者随后死亡。7例中有5例肾细胞癌的细胞病理学检查为阴性，这些患者活检后2 - 3年的后续影像学检查显示无肾肿块增大或转移（3例患者），或患者死于严重心脏病（2例患者）。其余6例患者接受了肾切除术，在切除2例嗜酸细胞瘤和4例肾细胞癌后2 - 4年未发现疾病证据。无明显并发症。
经皮肾穿刺活检细胞学检查在对有播散性转移或手术相对禁忌证的患者诊断肾细胞癌方面准确、安全且有用。
