Dupuy D E, Rosenberg A E, Punyaratabandhu T, Tan M H, Mankin H J
Radiology Department, Connective Tissue Oncology Center, Massachusetts General Hospital, Boston 02114, USA.
AJR Am J Roentgenol. 1998 Sep;171(3):759-62. doi: 10.2214/ajr.171.3.ajronline_171_3_001.
The purpose of our study was to assess the accuracy of CT-guided biopsy of musculoskeletal neoplasms with respect to technique, anatomic site, and histology.
During a 3-year period (January 1992 to December 1994), 176 core needle biopsies and 45 fine-needle aspirations were performed under CT guidance on patients with musculoskeletal neoplasms. To assess the accuracy of these procedures, we compared the diagnosis at biopsy with the final diagnosis as determined at the time of definitive treatment of the lesion. All biopsy findings were categorized as a primary malignancy (excluding round cell lesions), round cell lesion, local recurrence, or metastatic carcinoma. In addition, each lesion was analyzed according to which biopsy technique was used, whether frozen tissue section or rapid cytologic evaluation was used, and at which anatomic site the mass was found.
The accuracy for needle biopsy was 93% and that for fine-needle aspiration was 80%. The complication rate for both techniques was less than 1%. Accuracy rates for the four categories of primary malignancy, round cell lesion, local recurrence, and metastatic carcinoma were 87%, 75%, 94%, and 100%, respectively. The mismatch rates were similar in soft-tissue lesions (5/52) and bone lesions (16/169). Diminished accuracy was associated with round cell lesions (20%) and lesions located in the spine or the perivertebral region (20%). Nondiagnostic and insufficient specimens were found in 18 (8%) of the 221 patients. CONCLUSION. CT-guided biopsy of musculoskeletal malignancies is a safe and effective procedure if performed by a team of clinicians, pathologists, and radiologists who possess subspecialty expertise.
我们研究的目的是评估CT引导下肌肉骨骼肿瘤活检在技术、解剖部位和组织学方面的准确性。
在1992年1月至1994年12月的3年期间，对肌肉骨骼肿瘤患者在CT引导下进行了176次粗针活检和45次细针穿刺抽吸。为了评估这些操作的准确性，我们将活检诊断与病变最终治疗时确定的最终诊断进行了比较。所有活检结果分为原发性恶性肿瘤（不包括圆形细胞病变）、圆形细胞病变、局部复发或转移性癌。此外，根据使用的活检技术、是否使用冷冻组织切片或快速细胞学评估以及肿块所在的解剖部位对每个病变进行分析。
针吸活检的准确率为93%，细针穿刺抽吸的准确率为80%。两种技术的并发症发生率均低于1%。原发性恶性肿瘤、圆形细胞病变、局部复发和转移性癌这四类的准确率分别为87%、75%、94%和100%。软组织病变（5/52）和骨病变（16/169）的误诊率相似。准确率降低与圆形细胞病变（20%）以及位于脊柱或椎旁区域的病变（20%）有关。221例患者中有18例（8%）的标本未得出诊断结果或标本不足。结论。如果由具有专业特长的临床医生、病理学家和放射科医生团队进行CT引导下的肌肉骨骼恶性肿瘤活检，这是一种安全有效的操作。
