针芯穿刺活检对软组织肿瘤的病理诊断价值及影响因素分析

Diagnostic value of ultrasound-guided core needle biopsy for soft tissue tumors

目的研究软组织肿瘤针芯穿刺活检的病理诊断及临床应用价值，分析探讨影响穿刺活检病理诊断准确性的相关因素。方法将2007至2012年间106例原发性软组织肿瘤的穿刺活检标本病理诊断与相应病例的手术切除标本病理诊断对比，评价穿刺活检病理诊断的准确性，分析肿瘤组织形态特征，富于黏液间质组、梭形细胞组和其他形态类型组，以及恶性肿瘤中G1、G2和G3组（法国癌症中心联合会分级）等因素，与穿刺活检病理诊断准确性的相关性。以穿刺活检与切除标本病理诊断良性和恶性诊断符合率为标准，用x2检验对各组进行统计学比较。结果106例穿刺活检的诊断符合率84．0％（89／106），其余17例包括了无法评估诊断13例和4例诊断错误病例；该4例的术前诊断为良性肿瘤，而术后却为黏液性脂肪肉瘤和脂肪瘤样脂肪肉瘤，106例中未见良性肿瘤在穿刺时诊断为恶性肿瘤的过诊断。组织形态分组中，富于黏液间质组（9／17）符合率较低（P〈0．01）；59例恶性肿瘤中（总诊断符合率79．7％，47／59），而G1组（7／17）较低（P〈0．01），G3组为18／18。在良性和中间型组与恶性组、以及有无免疫染色组间比较分析，诊断符合率无差别。结论B超引导下软组织肿瘤针芯穿刺活检的病理诊断具有运用价值，尤其对于高级别肉瘤的术前放化疗，以及肿瘤手术方式的选择，有指导意义。而在富于黏液问质和脂肪源性肿瘤，以及低级别G1肉瘤的诊断符合率低，穿刺活检标本诊断时注意避免假恶性的过诊断，正确的诊断要结合临床和影像学综合分析判断。

Objective To study the diagnostic value and pitfalls of ultrasound-guided core needle biopsy （CNB） of soft tissue tumors. Methods One hundred and six cases of CNB specimens encountered during the period from 2007 to 2012 were enrolled into the study. The pathologic diagnosis using CNB was compared with that using surgical specimens. Diagnostic accuracy was analyzed using Chi-square test, with respect to the histologic pattern （such as spindle cell and myxoid）, biologic behavior （benign versus malignant） and immunohistochemical results. The 59 cases of sarcoma were subdivided into three grades according to FNCLCC grading system. Results Histologic diagnosis could be made in 84. 0% （89/106） cases. Thirteen cases were non-diagnostic on CNB. There were 4 cases on CNB showing diagnostic discrepancy with surgical specimens. Four cases of ＂benign lesions＂ on CNB found to be myxoid liposarcoma and lipoma-like liposarcoma upon resection. In general, myxoid pattern （9/17） seen on CNB showed less diagnostic correlation with surgical specimens, as compared to spindle cell and other histologic patterns （ P 〈 0.01）. The rate of diagnostic correlation was 79.7% （49/59） for the 59 cases of sarcoma studied, with grade 2 and grade 3 sarcoma showing better correlation （ in contrast to 7/17 for grade 1 sarcoma） （ P 〈 0. 01 ）. Comparative analysis showed no significant difference between benign / borderline tumors and sarcomas. The application of immunohistochemical study did not result in significant improvement in diagnostic accuracy on CNB. Conclusions Uhrasound-guided CNB is a reliable tool in pathologic diagnosis of soft tissue tumors and shows a high accuracy rate especially for high-grade sarcoma. Tumors with myxoidpattern, lipomatous tumors and grade 1 sarcomas are associated with lower diagnostic accuracy on CNB. Correlation with clinicoradiologic findings would also be helpful in diagnostic evaluation and surgical planning.