Renal mass core biopsy: Accuracy and impact on clinical management
Renal mass core biopsy: Accuracy and impact on clinical management
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DOI：
10.2214/ajr.06.0220
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发表时间：
2007-02-01
影响因子：
5
通讯作者：
Wood, David P., Jr.
中科院分区：
文献类型：
--
作者：
Maturen, Katherine E.;Nghiem, Hanh V.;Wood, David P., Jr.
目标。我们研究的目的是确定图像引导下经皮肾肿块活检的准确性及其对临床管理的影响。材料和方法。经机构审查委员会批准，我们回顾性地回顾了1999年2月至2005年7月期间我院放射科医生在成像引导下进行的肾脏活检。回顾了患者记录、病理报告和影像学检查。评估活检诊断与随访资料的一致性。与两位经验丰富的泌尿科医生合作确定了对临床管理的重大影响，并将其定义为从无治疗到治疗的变化，包括手术、肿瘤消融、化疗或放疗。在研究期间进行了276例肾脏活检。其中123例为随机活检，1例采用细针技术；这124人被排除在外。125例患者（女性55例，男性70例，平均年龄60岁，年龄范围28-90岁）采用同轴18号芯针技术进行了152例肾肿块活检。2例（1.3%）术后血肿（1例[0.7%]需要输血）和1例（0.7%）因活检导致的延迟性肾假性动脉瘤。未发现肿瘤播散。85例（56%）活检发现恶性肿瘤，61例（40%）活检发现良性肿瘤，6例（4%）未确诊。对恶性肿瘤的敏感性为97.7%；特异性,100%;阳性预测值100%；阴性预测值，100%。至少92例（60.5%）活检结果显著影响临床管理。影像学引导下经皮肾包块穿刺活检安全、准确。在大多数情况下，组织诊断可以改变临床决策，并可能避免一些不必要的肾切除术。
OBJECTIVE. The objective of our study was to determine the accuracy of imaging-guided percutaneous renal mass biopsy and its impact on clinical management.MATERIALS AND METHODS. With institutional review board approval, we retrospectively reviewed imaging-guided renal biopsies performed by radiologists at our institution between February 1999 and July 2005. Patient records, pathology reports, and imaging studies were reviewed. Concordance of biopsy diagnosis and follow-up data was assessed. Significant impact on clinical management was determined in collaboration with two experienced urologists and was defined as a change from no therapy to therapy, including surgery, tumor ablation, chemotherapy, or radiation.RESULTS. Two hundred seventy-six renal biopsies were performed during the study period. Of these, 123 were random biopsies and fine-needle technique was used for one; these 124 were excluded. One hundred fifty-two renal mass biopsies were performed using coaxial 18-gauge core needle technique in 125 patients (55 women, 70 men; average age, 60 years; range, 28-90 years). There were two (1.3%) postprocedural hematomas (one [0.7%] requiring blood transfusion) and one (0.7%) delayed renal pseudoaneurysm attributed to biopsy. No tumor seeding was identified. In 85 biopsies (56%), malignant neoplasm was found, 61 biopsies (40%) yielded benign findings, and six (4%) were nondiagnostic. The sensitivity for malignancy was 97.7%; specificity, 100%; positive predictive value, 100%; and negative predictive value, 100%. At least 92 (60.5%) biopsy results significantly impacted clinical management.CONCLUSION. Imaging-guided percutaneous core needle biopsy of renal masses is safe and highly accurate. Tissue diagnosis alters clinical decision making in a majority of the cases and may allow a number of unnecessary nephrectomies to be avoided.