Value of CT-guided Core Needle Biopsy in Diagnosing Spinal Lesions: A Comparison Study
Value of CT-guided Core Needle Biopsy in Diagnosing Spinal Lesions: A Comparison Study
复制标题
CT引导下空芯针活检诊断脊柱病变的价值：比较研究
DOI：
10.1111/os.12418
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发表时间：
2019-02-01
影响因子：
2.1
通讯作者：
Dong, Jian
中科院分区：
文献类型：
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作者：
Liang, Yun;Liu, Peng;Dong, Jian
目的：方法：回顾性分析2013年4月至2017年7月在我院行CT引导下空芯针穿刺活检诊断脊柱病变的临床资料，并与C型臂引导下进行比较。男96例，女92例，平均年龄57.1岁。共进行了238次空芯针活检。102例患者在C臂引导下共进行了140次空芯针活检（组1）; 86例患者在CT引导下进行了98次空芯针活检（组2）;胸椎108次空芯针活检，腰椎116次，骶椎14次。78例患者在活检后接受手术治疗。对于这些患者，比较活检和手术的组织病理学，以评估活检的准确性。对于未接受手术治疗的其他110例患者，使用治疗反应和临床病程来评估活检的准确性。结果：C臂引导组（第1组）与CT引导组（第2组）在性别、年龄、病变部位等方面均无显著性差异。两组均无并发症发生。在238例活检中，232例确立了病理诊断。结果显示，52例为原发性恶性肿瘤，12例为良性肿瘤，70例为转移性肿瘤，4例为结核病，94例为其他。第2组的成功率高于第1组，但无统计学意义（95.7% vs 100%; P=0.098）。根据最终诊断结果，计算并比较两组的诊断准确率。两组间无显著性差异（95.5% vs 96.9%; P=0.835）。采用Kappa系数分析两组活检病理与最终诊断的一致性。两组的Kappa值分别为0.909和0.939。结论：CT引导下粗针穿刺活检对脊柱病变的诊断准确率高，并发症少，是一种相对安全、有效的诊断方法。
Objective: A retrospective study was designed to evaluate the effectiveness of CT-guided core needle biopsy in diagnosing spinal lesions through comparison with C-arm guidance.Methods: From April 2013 to July 2017, a total of 188 patients, who suffered from spinal lesions or had malignant tumor history with a new spinal fracture, were included in this study. There were 96 men and 92 women, with an average of 57.1years. A total of 238 core needle biopsies were performed. A total of 140 core needle biopsies were carried out under C-arm guidance in 102patients (group1); 98 core needle biopsies were carried out under CT guidance in 86 patients (group 2); 108 core needle biopsies were performed in thoracic vertebrae, 116 were in lumbar vertebrae, and 14 were in sacral vertebrae. Seventy-eight patients accepted surgical treatment after biopsies. For these patients, the histological pathologies of the biopsy and surgery were compared to evaluate the accuracy of the biopsy. For the other 110 patients who did not receive surgical treatment, the treatment response and the clinical course were used to evaluate the accuracy of the biopsy. The success rate, the diagnostic accuracy rate, the true positive/negative rate, and complications of the two groups were calculated and compared.Results: There were no significant differences in sex, age, and lesion sites between the C-arm guidance group (group 1) and the CT guidance group (group 2). There were no complications in the two groups. Pathological diagnoses were established in 232 of 238 biopsies. They revealed that 52 were primary malignant tumors, 12 were benign tumors, 70 were metastatic tumors, 4 were tuberculosis, and 94 were classified as other. The success rate of group 2 was higher than that of group 1, but it was not statistically significant (95.7% vs 100%; P=0.098). According to the final diagnosis, the diagnostic accuracy rates were calculated and compared. There was no significant difference between the two groups (95.5% vs 96.9%; P=0.835). The kappa coefficient was used to analyze the concordance between the histological pathologies of the biopsy and the final diagnosis in the two groups. The kappa values of the two group were 0.909 and 0.939, respectively. The results showed good consistency in both groups, but seemed better for group 2.Conclusion: CT-guided core needle biopsy is a relatively safe and effective procedure for diagnosing spinal lesions with a high diagnostic accuracy rate and few complications.