骨肿瘤病理活检有效性的影响因素分析

Study for effectiveness of core-needle biopsy and open biopsy of bone lesions

[目的]评价骨骼系统病变病理活检的有效性;明确影响活检准确率的独立危险因素,并分析该因素对穿刺活检后导致切开活检几率的影响。[方法]回顾性分析2003年6月～2006年10月间共206例骨破坏病例,所有病例均进行芯针穿刺或切开活检。比较活检病理结果与术后病理结果是否一致,将病理活检结果分为正确、无诊断和错误3种。将结果正确的活检定义为有效活检;将结果错误和无诊断的活检定义为无效活检。分析下列因素对活检有效性的影响:活检方式、病变位置、黏液成分、病变种类,明确病理活检有效性的独立危险因素;同时分析其对阴性穿刺结果导致切开活检发生率的影响。[结果]206例患者中,147例(71.4%)患者行芯针穿刺活检,47例(22.8%)行切开活检,12例(5.8%)患者进行芯针穿刺后,再次进行切开活检。176例(85.4%)活检结果正确,19例(9.2%)无诊断,11例(5.3%)活检结果错误。Logistic多因素回归分析提示病变含有黏液成分是影响活检正确率的独立危险因素(P=0.02)。[结论]大部分骨骼系统病变通过芯针穿刺活检或切开活检可以明确诊断。病变内有黏液成分会降低活检诊断的正确率;没有单一因素增加切开活检几率。骨骼系统病变的正确诊断仍需依靠临床、病理及影像三结合的模式。

[ Objective ] To evaluate the effectiveness of biopsy of bone lesions. The factors that might effect on the clinical utility were analyzed in order to find out the independent factor for clinical effectiveness. Also we evaluated the effects of these factors on the open biopsy with needle biopsy previously done. [ Method ] We retrospectively reviewed 206 cases performed at our institute between June 2003 and Oct 2006, including percutaneous core-needle biopsy or open biopsy. The biopsy result was classified as correct, nondiagnostic, or incorrect. The biopsy results were considered clinical useful if they were correct and not useful if they were nondiagnostic or incorrect. We identified the independent risk factor by analyzing whether the characteristics including biopsy methods, lesion position, myxoid, lesion type reduced the effect on the clinical utility and increased the probability of proceeding to subsequent open biopsy. [ Result] In 206 patients, one hundred and forty-seven cases （71.4%） underwent core-needle biopsy. Forty-seven cases （22.8%） underwent open biopsy and twelve cases （5.8%） had open biopsy with needle biopsy first. One hundred and seventy-six cases （85.4%） patients had clinical useful results. Eighteen cases （8.7%） were nondiagnostic, and twelve cases （5.8%） were incorrect, Myxoid histology was identified of independent risk factor on the clinical utility by logistic regression （P = 0. 02）. [ Conclusion] Most cases of bone lesions can be diagnosed by core-needle biopsy or open biopsy. The myxoid histology is associated with decrease clinical accuracy; No single characteristic cause increase probability of open biopsy. Correct diagnose of bone lesions requires combining biopsy, radiology and clinical data.