超声或CT引导下穿刺活检在骨肉瘤诊断中的应用

Percutaneous ultrasound or CT guided biopsy in the diagnosis of osteosarcoma

目的:探讨CT或B超引导下穿刺活检技术在诊断骨肉瘤中的应用。方法:回顾性分析2003-12-01-2011-12-01我院诊治的60例四肢骨肉瘤患者的临床资料,21例骨质异常无软组织包块者行CT引导下经皮穿刺活检,39例有软组织包块者行B超引导下经皮穿刺活检,经皮穿刺活检结果与手术后病理进行比较。结果:39例行B超穿刺活检,36例有明确病理诊断且与术后病理相符,准确率为92.31%,有3例不能明确诊断,后经切开活检确诊为骨肉瘤。21例CT引导下经皮穿刺活检,17例有明确病理诊断,准确率为80.95%;总体经皮穿刺活检的准确率为88.33%。无出血、血肿形成、感染和血管神经损伤等并发症的发生。其中1例误诊患者穿刺活检诊断为"水肿的肌肉组织",术后病理示"普通型骨肉瘤";另1例穿刺活检诊断为"脂肪组织",病理示"骨内高分化骨肉瘤"。结论:经皮穿刺活检技术是诊断骨肉瘤比较可靠的方法;B超引导下经皮穿刺骨肉瘤骨外软组织包块,具有较高的准确率。

OBJECTIVE： To analyze the application of percutaneous CT or ultrasound-guided biopsy in the diagnosis of osteosarcoma. METHODS： This retrospective study included 60 cases of osteosarcoma treated from 12-01-2003 to 12- 01-2011. Of those 60 cases,21 were performed with use of computed tomography （CT） guidance to target the osseous ab- normality without extraosseous mass. Totally 39 cases with extraosseous soft tissue mass were performed with use of ul- trasonography （US）. The result of percutaneous biopsy were compared with the pathology after surgery. RESULTS： Of the 39 tumors performed with ultrasound-guided biopsy, 36 were definitively diagnosed as osteosarcoma （92. 31%）. A- mong the 39 tumors,3 cases had no definitive diagnose,which were diagnosed as osteosarcoma by the method of open bi- opsy. Seventeen of the 21 CT-guided biopsies were conclusive （80.95%）. All 60 percutaneous can result in a diagnostic ac- curacy as high as 88.33 %. There were no complication such as hemorrhage, hematoma,infection and vascular or nerve in- juries. One misdiagnose pereutaneous biopsy diagnosed as dropsical musculature then pathology diagnosed as eommunis osteosarcoma,another percutaneous biopsy diagnosed as axunge tissue then pathology diagnosed as high differentiate os- teosarcoma. CONCLUSIONS.. Percutaneous biopsy is safe and accurate method for diagnosis of osteosareoma. US-guided biopsy of the extraosseous soft-tissue mass is a highly accurate diagnostic tool.