Success Rate and Utility of Ultrasound-guided Synovial Biopsies in Clinical Practice
Success Rate and Utility of Ultrasound-guided Synovial Biopsies in Clinical Practice
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DOI：
10.3899/jrheum.151441
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发表时间：
2016-12-01
影响因子：
3.9
通讯作者：
Le Goff, Benoit
中科院分区：
文献类型：
--
作者：
Najm, Aurelie;Orr, Carl;Le Goff, Benoit
Objective.滑膜活检在增加我们对炎性关节病发病机制的了解以及评估治疗方面的作用已经得到了很好的证实。超声（US）允许滑膜评估，因此有助于以安全和耐受性良好的方式对滑膜组织进行活检。本研究的目的是（1）确定使用超声引导下获取滑膜组织的成功率，（2）描述临床环境中超声引导下滑膜活检的适应症，（3）确定滑膜活检的频率可以导致明确的诊断，以及（4）评估使用该技术获得的滑膜组织的质量。在2007年2月至2014年12月期间，在美国指导下使用半自动芯活检针对小关节和大关节进行滑膜活检。如果在组织学检查中发现滑膜组织，则认为活检程序成功。74例未分化关节炎患者进行了76次滑膜活检。滑膜组织取出成功率为81.6%（62/76）。1例患者在活检时服用乙酰水杨酸75 mg，术后48 h出现关节积血，经简单关节穿刺后消退。16%的患者成功采集了滑膜组织样本，获得了明确的诊断。在临床实践中，超声引导下滑膜活检可以安全地对未分化关节炎和异质性表现的患者进行。获取滑膜组织的成功率很高。该手术通常会获得高质量的组织，并在极少数患者中得到明确的诊断。
Objective. The utility of synovial biopsy in increasing our understanding of the pathogenesis of inflammatory arthropathies, as well as in evaluating treatments, is well established. Ultrasound (US) allows synovial assessment and therefore assists in biopsying synovial tissue in a safe and well-tolerated manner. This study's objectives were to (1) determine the rate of success in retrieving synovial tissue using US guidance, (2) describe the indications for US-guided synovial biopsies in the clinical setting, (3) determine how frequently the synovial biopsy can lead to a clear diagnosis, and (4) assess the quality of the synovial tissue obtained using this technique.Methods. Synovial biopsies of small and large joints were performed under US guidance between February 2007 and December 2014 using a semiautomatic core biopsy needle. The biopsy procedure was considered successful if synovial tissue was found at histological examination.Results. Seventy-four patients with undifferentiated arthritis underwent 76 synovial biopsies. The success rate in retrieving synovial tissue was 81.6% (62/76). One patient taking acetyl salicylic acid at 75 mg at the time of the biopsy presented with hemarthrosis 48 h after the procedure, which resolved following simple arthrocentesis. A definitive diagnosis was achieved in 16% of the patients where synovial tissue was sampled successfully.Conclusion. US-guided synovial biopsies in clinical practice can be performed safely on patients with undifferentiated arthritis and with heterogeneous presentations. The rate of success in acquiring synovial tissue is high. The procedure usually retrieves quality tissue and leads to a definite diagnosis in a significant minority of patients.