目的:构成动脉瘤性骨囊肿(ABC)的薄而脆弱的隔膜可能是经皮活检的目标。这项研究的目的是描述和评估一种使用心内膜活检钳进行ABC活检的新方法,以尝试捕获较大的组织碎片进行诊断。
方法:这是一项为期17年的回顾性研究。<18岁的患者接受了推定ABC的经皮活检,基于术前成像,包括在内。医疗记录被审查以确定年龄,性别,病变位置,活检程序细节,并发症,和病理结果。诊断性活检被定义为决定性的组织学确认。不确定的发现或暗示但不诊断ABC的发现被视为非诊断性,即使影像学和临床表现是特征性的。活检设备的选择和获得的组织数量由儿科介入放射科医师自行决定。Fisher精确检验用于比较标准活检与使用活检钳的诊断结果。
结果:对18例患者(11例女性)进行了23次活检,中位年龄为14.7岁(IQR10.6-15.6)。病变位于四肢(7,30.4%),胸部(6,26.1%),骨盆(5,21.7%),脊柱(4,17.4%),和下颌骨(1,4.3%)。使用13或15号骨取芯针(11,47.8%)获得标本;14-,16-,或18号软组织针(6,26.1%);或骨骼和软组织针的组合(4,17.4%)。使用心内膜活检钳7例(30.4%),2,它是唯一使用的设备。总的来说,在13/23(56.5%)的活检中做出了决定性的病理诊断.在诊断性活检中,1为单房骨囊肿,其他均为ABCs。未发现恶性肿瘤。与标准方法相比,使用镊子更有可能导致诊断性活检(40.0%vs100.0%,p=0.008)。没有并发症。
结论:心内膜活检钳提供了额外的,对推测的ABCs进行活检的新技术,可能会提高诊断率。
OBJECTIVE: The thin and friable septations composing aneurysmal bone cysts (ABC) may be challenging to target for percutaneous biopsy. The purpose of this study was to describe and evaluate a novel method of ABC biopsy using endomyocardial biopsy forceps as an attempt to capture larger fragments of tissue for diagnosis.
METHODS: This was a retrospective study performed over a 17-year period. Patients <18 years old who underwent percutaneous biopsy for a presumed ABC, based on pre-procedure imaging, were included. Medical records were reviewed to identify age, sex, lesion location, biopsy procedure details, complications, and pathology results. A diagnostic biopsy was defined as conclusive histologic confirmation. Inconclusive findings or findings suggestive of but not diagnostic of an ABC were treated as non-diagnostic, even if imaging and clinical findings were characteristic. Biopsy device selection and quantity of tissue obtained was at the discretion of the pediatric interventional radiologist. Fisher\'s exact test was used to compare the diagnostic yield of standard biopsies to those employing biopsy forceps.
RESULTS: Twenty-three biopsies were performed in 18 patients (11 female) with a median age of 14.7 years (IQR 10.6-15.6). Lesions were located in the extremities (7, 30.4%), chest (6, 26.1%), pelvis (5, 21.7%), spine (4, 17.4%), and mandible (1, 4.3%). Specimens were obtained using a 13- or 15-gauge bone coring needle (11, 47.8%); 14-, 16-, or 18-gauge soft tissue needle (6, 26.1%); or a combination of bone and soft tissue (4, 17.4%) needles. Endomyocardial biopsy forceps were utilized in 7 cases (30.4%), 2 in which it was the only device used. Overall, a conclusive pathologic diagnosis was made in 13/23 (56.5%) biopsies. Of the diagnostic biopsies, 1 was a unicameral bone cyst and all others were ABCs. No malignancy was identified. Compared to the standard approach, the use of forceps was more likely to result in a diagnostic biopsy (40.0% vs 100.0%, p = 0.008). There were no complications.
CONCLUSIONS: Endomyocardial biopsy forceps offer an additional, novel technique to biopsy presumed ABCs and may improve diagnostic yield.