CT导引下穿刺活检对胰腺占位性病变的诊断价值

Evaluation of CT-guided biopsy in diagnosing space-occupying lesions of the pancreas

目的探讨CT导引穿刺活检胰腺占位性病变的诊断价值。方法回顾性分析CT导引细针穿刺胰腺占位性病变68例,其中胰头区病变49例、胰体12例和胰尾7例。病灶直径2～7 cm,<3cm 10例,3～7 cm 58例。术前均作CT平扫和增强扫描,均采用前路进针,使用20 G细针穿刺。活检标本送病理科作组织病理检查。结果68例患者均安全地穿刺到病变内,活检成功率为100%。穿刺活检诊断率为恶性病变46例,良性17例,5例未见病变。5例中2例经临床和CT随访均无异常,另3例最终证实胰腺囊腺癌2例和胃癌转移1例。穿刺活检总正确率、灵敏度和特异度分别为96%、95%和100%。CT导引活检对恶性、良性病变的正确率为94%和100%(P>0.05)。较大肿块病灶(≥3.0 cm 97%,<3 cm90%)和病变位于胰尾(胰尾100%,胰头96%,胰体92%)的正确率稍高,但经统计学检验正确率差异并无统计学意义(P>0.05),未发现严重的并发症。结论CT导引经皮细针穿刺活检胰腺占位性病变是一种安全的有效的诊断和鉴别诊断的方法。

Objective To assess the diagnostic value of CT-guided percutaneous fine-needle aspiration biopsy（FANB） for the space-occupying lesions of the pancreas.Methods The authors retrospectively reviewed the medical records of 68 patients with pancreatic lesions who underwent CT-guided percutaneous fine-needle aspiration biopsy.The lesions were located at the pancreatic head（n = 49）,body（n = 12） or tail（n = 7）.The maximum diameter of the 68 lesions ranged from 2 cm to 7 cm.The lesion’s diameter was 〈 3 cm in 10 cases and was ≥ 3 cm in 58 cases.A 20-gauge fine-needle was used to puncture and to make the aspiration in all patients.Both plain and contrast-enhanced abdominal CT scanning were performed before the biopsy procedure.The technical key points of aspiration biopsy included selection of the appropriate cross-section,the entry of the needle,and multiple insertions in fan-like fashion with fast manipulation of puncture and aspiration.All biopsy specimens were sent for pathologic evaluation.Results All the lesions were safely and successfully punctured through the anterior approach without major complications.The technical success of needle puncturing was 100%.Of 68 patients,the pathological results obtained from the biopsy included malignant tumor in 46,benign lesion in 17 and no abnormal finding in 5,of which follow-up observation found no abnormality in 2 and malignant process was eventually confirmed in remaining three.The overall accuracy,specificity and sensitivity of the biopsy were 96%,95% and 100%,respectively.The accuracy of CT-guided biopsy for malignant and benign lesions was 94% and 100% respectively（P 〉 0.05）.The diagnostic accuracy for lesions larger than 3.0 cm（97%） or located at the pancreatic tail（100%） was a little higher than that for lesions smaller than 3.0 cm（90%） or located at the pancreatic head（96%） or body（92%）,although the difference was not statistically significant（P 〉 0.05）.No serious complications occurred in our series.Conclusion CT-guided percutaneous fine-needle aspiration biopsy is a safe and effective technique for the diagnosis and differentiation of the space-occupying lesions of the pancreas.