超声弹性成像技术对提高肝肿瘤穿刺活检确诊率的应用价值

Ultrasonic elastography technology in raising the accuracy of biopsy for liver neoplasms

目的探讨超声弹性成像技术对提高肝肿瘤穿刺活检确诊率的应用价值。方法将126例肝肿瘤患者（共141个肝脏肿块）随机分为弹性组（70个肿块）和对照组（71个肿块）。对弹性组行超声弹性成像检查,分别对肿块进行弹性评分及应变率比值测定,然后参照弹性图特点行超声引导下肝肿瘤穿刺活检;对照组只采用常规超声引导肝肿瘤穿刺活检。以病理结果为金标准,对比分析两种方法对肝肿瘤的穿刺成功率、取材满意度和确诊率。结果以1针为穿刺成功标准,对照组和弹性组的穿刺成功率分别为29.58%（21/71）、64.29%（45/70）,二者差异有统计学意义（χ^2=17.05,P〈0.01）;以≤2针为穿刺成功标准,弹性组穿刺成功率明显高于对照组[95.71%（67/70）vs 85.92%（61/71）,χ^2=4.04,P=0.04]。以取出长度约10-22mm的完整组织条或取材量满足病理诊断为取材满意,对照组和弹性组的取材满意度分别为81.20%（108/133）、93.88%（92/98）,差异有统计学意义（χ^2=7.80,P=0.01）。弹性组与对照组总确诊率差异有统计学意义[95.71%（67/70）vs 84.51%（60/71）,χ^2=4.95,P=0.03]。结论超声弹性成像可敏感反应肿瘤组织的软硬程度、准确分辨肝肿瘤内的液化坏死区,对提高肝肿瘤穿刺活检确诊率具有重要的价值。

Objective To evaluate the clinical utility of ultrasonic elastography（UE）technology in percutaneous liver biopsy of liver neoplasms.Methods A total of 126 patients with 141 liver tumors were randomly divided into two groups：UE group（70 liver tumors）underwent liver biopsy directed by ultrasonic elasticity and then the elasticity score and strain ratio,and routine ultrasound（US）group（71 liver tumors）underwent biopsy guided by conventional ultrasonography.Taking pathological result as the golden standard,contrast analysis of two kinds of methods for liver tumor puncture success rate,material satisfaction and diagnosis rate was performed.Results With a needle puncture success criteria,the success rate of puncture in US and UE were 29.58%（21/71） and 64.29%（45/70）,respectively,the difference between the two groups was statistically significant（χ^2=17.05,P〈0.01）.The success rate of puncture in UE was significantly higher than that of US if the puncture was less than or equal to 2 needle（85.92% [61/71]vs 95.71% [67/70],χ^2=4.04,P=0.04）.To take out the length of about 10-22 mm of the complete tissue strips or the amount of material to meet the pathological diagnosis for the material,the satisfaction rate of the US group and the UE group were 81.20%（108/133）,93.88%（92/98）,the difference was statistically significant（χ^2=7.80,P=0.01）.In addition,a significant difference in total diagnosis rate was observed between US group and UE group（84.51% [60/71]vs 95.71% [67/70],χ^2=4.95,P=0.03].Conclusion UE can be used to distinguish liquefaction necrosis in the liver tumor area accurately by the reflection of the hard and soft degree of tumor tissue,and it is worthy for increasing the confirmed diagnosis rate of puncture.