肾肿瘤穿刺活检病理诊断的准确性及意义

Accuracy and Significance of Pathological Diagnosis of Renal Tumors by Biopsy

目的探讨肾肿瘤穿刺活检(renal mass biopsy,RMB)对肾肿瘤诊断的准确性和意义.方法收集2012年8月至2016年7月福建省立医院泌尿外科因诊断肾肿瘤行根治性肾切除术、保留肾单位肾部分切除术和姑息性肾切除术等术后标本54份,使用16G自动穿刺活检枪对切除肿瘤组织中央区及周边区分别进行穿刺,穿刺组织制作病理切片并进行病理诊断,将穿刺组织病理结果和术后病理结果进行对比,研究RMB诊断肾肿瘤良恶性、组织学分型分级的准确性.结果共收集肾肿瘤组织54份,男32例,女22例,年龄36~79岁,中位年龄54.9岁,影像学肾肿瘤直径2.2~15.3 cm,中位数4.51 cm.术后病理报恶性肿瘤46例,其中肾透明细胞癌39例,嫌色细胞癌5例,乳头细胞癌2例;良性肿瘤8例,均为血管平滑肌脂肪瘤.RMB的良恶性诊断准确率为100.00%,Kappa=1.00(P<0.001);RMB的肾细胞癌组织亚型诊断准确率95.65%,Kappa=0.837(P<0.001);RMB对Fuhrman分级诊断准确率为65.00%,Kappa=0.443,P<0.001;依据1997年WHO推荐的核分级方法,准确率可达到80.00%,Kappa=0.545(P<0.001).结论RMB对肾肿瘤良恶性和肾细胞癌亚型准确性很高,与术后病理对照一致性很高,而Fuhrman分级诊断准确性不高,一致性不佳,但按照1997年WHO推荐核分级标准则准确性会明显提高.

Objective This study aimed to investigate the accuracy and significance of renal mass biopsy(RMB)in the diagnosis of renal tumors.Methods A total of 54 specimens were collected from August 2012 to July 2016,after patients received radical nephrectomy,partial nephroectomy or palliative nephrectomy.The central and peripheral areas of the tumors were punctured with a 16G automatic puncture biopsy gun,and the puncture tissue was used for pathological diagnosis.The accuracy of the classification of the grade of the renal tumors,including benign and malignant renal tumors,was studied by comparing the histopathological results with the postoperative pathological results.Results The 54 renal tumor tissues were collected from 32 men and 22 women 36-79 years of age,with a median age of 54.9 years.Imaging indicated that the renal tumors had a diameter of 2.2-15.3 cm,with a median of 4.51 cm.A total of 46 cases of malignant tumors were reported pathologically,including 39 cases of renal clear cell carcinoma,five cases of chromophophous cell carcinoma and two cases of papillary cell carcinoma;eight cases of benign tumors were angiomyolipomas.The accuracy of the diagnosis of RMB was 100.00%,Kappa=1.00(P<0.001).The accuracy of diagnosis of the renal cell carcinoma subtype was 95.65%,Kappa=0.837(P<0.001).The accuracy of the classification diagnosis by RMB was 65.00%,Kappa=0.443(P<0.001).According to the nuclear classification method recommended by the WHO in 1997,the accuracy rate reached 80.00%,Kappa=0.545(P<0.001).Conclusion The accuracy of RMB is very high for benign and malignant renal tumors and renal cell carcinoma subtypes,and the consistency with postoperative pathology is high.The accuracy of Fuhrman classification diagnosis is not high,and the consistency is not good,but the accuracy will be improved according to the nuclear classification standard recommended by the World Health Organization in 1997.