CT引导下同轴穿刺活检对骨盆病变的诊断价值  

CT-guided coaxial percutaneous core needle biopsy in the diagnosis of pelvic lesions

作　　者：齐典文[1] 陈洪义[1] 高丽 赵茗[1] 周庄[1] 郭昶志 孙涛[1] 胡彤宇[1] 张国川[1] QI Dian-wen;CHEN Hong-yi;GAO Li;ZHAO Ming;ZHOU Zhuang;GUO Chang-zhi;SUN Tao;HU Tong-yu;ZHANG Guo-chuan(Musculoskeletal Oncology Department of Hebei Medical University third Hospital,Key Biomechanical Laboratory of Orthopedics of Hebei Province,Shijiazhuang,Hebei,050051,China)

机构地区：[1]河北医科大学第三医院骨与软组织肿瘤科、河北骨科生物力学重点实验室,石家庄050051 [2]河北省直属机关第一门诊部,石家庄050051

出　　处：《中国骨与关节杂志》2018年第7期542-546,共5页Chinese Journal of Bone and Joint

基　　金：河北省科技厅重点研发计划项目健康医疗与生物医药专项(18277798D)

摘　　要：目的探讨CT引导下同轴穿刺在骨盆病变诊断中的应用价值。方法回顾性分析62例于2014年1月至2016年12月间在我科行CT引导下同轴穿刺活检的骨盆病变患者的病例资料,并随访其后续的诊治情况。以手术后病理结果和(或)临床随访(至少为6个月)作为穿刺病理的评价标准,以评价活检在鉴别病变是否为恶性的表现。而且,分析穿刺结果对治疗方案的影响。结果本研究纳入患者62例,男29例,女33例,平均54(12~84)岁。其中,最终诊断经手术病理确诊者41例,随访确诊者21例。穿刺活检在鉴别病变是否为恶性方面的敏感性、特异性、准确率、阳性预测值、阴性预测值分别为94%,100%,95%,100%,80%。所有患者中出现并发症2例,均为穿刺后局部血肿形成。本组共有35%(22/62)的患者穿刺前后治疗方案进行了调整:18例穿刺前拟行手术切除,穿刺后改行非手术治疗;4例手术方式发生变化,穿刺前拟行广泛切除,穿刺后仅行病灶刮除或清理术。结论 CT引导下同轴穿刺在骨盆病变术前诊断中,尤其在良恶性病变鉴别方面,具有较高的敏感性,特异性及准确率,而且安全性好。可为制订正确的临床决策提供可靠的依据。Objective To investigate the clinical value of CT-guided coaxial core needle biopsy（ CNB） in the diagnosis of pelvic lesions. Methods A total of 62 patients with pelvic lesion underwent CT-guided coaxial core needle biopsy（ CNB） between January 2014 and December 2016. And all patients were followed up for at least 6 months. The pathologic findings and/or clinical follow-ups were taken as the recognition criteria to evaluate the performance of CNB, esp. the performance of differentiating the malignant lesions from the benign ones. The information following the biopsy was also collected. Results There were 29 males and 33 females, with the mean age of 54 years（ range： 12-84 years）. The pathologic findings were utilized to judge the performance of CNB in 41 patients, and clinical follow-ups were used in the other 21 patients. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CNB in the differentiation of malignancy from benign lesions were 94%, 100%, 95%, 100%, and 80% respectively. Two patients experienced the complication of hematoma following the procedure. Based on the biopsy findings, treatment was altered in 35%（ 22/62） patients. Presumed surgery was replaced by medication in 18 patients, and the excision type changed in 4 patients. Conclusions CT-guided coaxial CNB is an effective and safe method with high sensitivity, specificity and accuracy in the diagnosis of pelvic lesion, esp. in the differentiation of malignancy from benign lesions. With CNB, more reliable evidence could be available for the proper clinical decisionmaking.

关 键 词：CT 骨盆 活组织检查 针吸 诊断 

分 类 号：R445[医药卫生—影像医学与核医学] R681.6[医药卫生—诊断学]