超声引导下粗针穿刺活检诊断肢体骨及软组织病变的准确性分析  

Diagnostic accuracy in limb musculoskeletal lesions by ultrasound-guided core needle biopsy

作　　者：王昀[1] 刘爱军[1] 王月香[2] 韦立新[1] 王殿军[1] 

机构地区：[1]解放军总医院病理科,北京100853 [2]解放军总医院超声科,北京100853

出　　处：《诊断病理学杂志》2010年第4期249-252,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨超声引导下粗针穿刺活检在肢体软组织及骨病变诊断中的应用价值,分析粗针穿刺活检标本病理诊断的影响因素,以提高病理诊断的准确性。方法收集超声引导下粗针穿刺活检的四肢骨及软组织肿瘤77例,观察粗针穿刺活检标本的病理形态,并对其中23例行免疫组化染色,对比研究与之相应的手术切除标本的病理检查结果。结果通过HE染色和/或免疫组化染色,穿刺标本确诊或基本确诊51例(66.2%);提出倾向性诊断21例(27.3%);组织太少不足以诊断5例(6.5%);诊断阳性率(或称敏感性)为93.5%(72/77)。能正确判断良、恶性者71例,特异性达98.6%(71/72);肿瘤假阴性诊断率1.4%(1/72),无假阳性诊断。17例明确了病变性质,但病理类型欠准确,诊断准确率为75%(54/72)。结论超声引导下粗针穿刺活检四肢骨与软组织病变的病理诊断需结合临床和影像学资料,必要时选择适当的免疫组化套餐,可以得到较高的确诊率。Objective To investigate the diagnostic accuracy in limb musculoskeletal lesions by ultrasound-guided core needle biopsy （CNB）. Methods Prospective study was performed, and the diagnosis of 77 cases of ultrasound-guided CNB specimens were compared with the final diagnosis obtained by surgically-removed specimen. Results By using the routine haematoxylin-eosin staining and/or immunohistochemistry, 72 cases were determined to be adequate for pathological diagnosis, the sensitivity was 93. 5%; fifty-one out of 72 cases （66.2%） were arrived at a specific diagnosis, 21 （27. 3% ） cases got the suggestive diagnosis. Compared to the final diagnosis, 71 cases were correct in differentiating benign from malignant nature of the lesion, and the specificity was 98.6% （ 71/72 ） . And 17 cases with nature determination could not be classified into a definitive pathological type. Pseudo-negative diagnosis accounted for 1.4% （ 1/ 72）, and no pseudo-positive diagnosis. The overall accuracy was 75.0% （54/72）. Conclusion The pathological diagnosis on ultrasound-guided core needle biopsy in the limb musculoskeletal lesions has high accuracy; it is helpful and important to combine the clinical, imaging data and histological examination in arriving at a correct diagnosis.

关 键 词：骨肿瘤 软组织肿瘤 芯针穿刺活检 超声波引导 

分 类 号：R445.1[医药卫生—影像医学与核医学]