单中心14年B超引导下经皮肾肿物穿刺活检经验

Percutaneous biopsy of the renal masses under ultrasound: a single-center 14 years experience

目的:评价B超引导下经皮肾肿物穿刺活检(renal masses biopsy,RMB)的诊断效果、安全性及在中晚期肾癌患者中的临床应用价值。方法:回顾性分析2001年4月至2014年12月在北京大学第一医院行B超引导下肾肿物穿刺活检的75例患者的临床病理资料,总结肿瘤大小、病理分型和分级、穿刺部位、穿刺针数以及诊断效果等数据,分组统计分析。结果:北京大学第一医院14年来B超引导下RMB数量呈明显增加趋势。共75例患者纳入本研究,确诊64例(85.3%),包括60例恶性肿瘤,4例良性病变;非诊断性穿刺11例(14.7%)。60例恶性肿瘤中,肾细胞癌37例(61.7%),尿路上皮癌13例(21.7%),其他肿瘤10例(16.7%)。37例肾细胞癌中明确诊断病理学亚型33例(89.2%),无法明确病理学亚型4例(10.8%)。75例患者中,集合管癌占肾癌10.8%,鳞癌占尿路上皮癌23.1%,比例均高于已报道流行病学数据(2%,9.9%)。75例患者中,13例行手术治疗并取得术后病理,穿刺活检结果与术后病理结果相比,肿物良恶性、病理学亚型及病理分级诊断的准确率分别为100%、81.8%和60.0%。75例患者中1例(1.3%)出现轻微血尿,未出现其他相关并发症。结论:B超引导下RMB可准确诊断肾癌病理学亚型,指导晚期肾癌患者靶向治疗;RMB可较准确判断恶性程度较高的集合管癌、尿路上皮鳞癌,可为制定合理的治疗方案提供参考。

Objective： To assess the diagnostic rate,safety and clinical application of percutaneous renal masses biopsy for advanced renal cell carcinoma patients. Methods： In this retrospective study,we collected the data of renal masses from the patients who underwent renal masses biopsy under ultrasound from April 2001 to December 2014 in Peking University First Hospital. A total of 75 patients who were undiagnosed or diagnosed with advanced renal cell carcinoma by the imageological method were enrolled in this study. The patient and lesion characteristics such as tumor size,pathology of tumor,histologic subtype,pathological grade,biopsied location and biopsied cores were recorded and analyzed. Results：Among all the 75 patients,biopsy was diagnostic in 64 cases（85. 3%） and non-diagnostic in 11 cases（14. 7%）. Of the 64 diagnostic biopsies,60 were malignant,including 37（61. 7%） renal cell carcinoma（RCC）,13（21. 7%） urothelial carcinoma and 10（16. 7%） other malignant masses. Of all the RCC subjects,24 suffered from clear cell RCC,5 papillary RCC,3 collecting duct carcinomas,1 unclassified RCC and 4 unknown subtypes. The 11 non-diagnostic biopsied samplings included inflammatory,blood and extrarenal tissue and normal renal tissue. The proportion of collecting duct carcinoma in RCC was 10. 8% and the proportion of squamous carcinoma in urothelial carcinoma was 23. 1%,which were both higher than the previous research findings. For the male and female groups,non-diagnostic yields were 6. 5% and 30. 4%,respectively（P = 0. 022）. Of all the 75 patients,13 renal cell carcinoma patients underwent the surgical treatment and got the results of postoperative pathology. Comparing preoperative biopsy pathological diagnosis with postoperative pathological diagnosis,we found the diagnostic correct rates for benign and malignant lesions,pathological subtype and pathological grade were100%,81. 8% and 60%,respectively. Mild macroscopic hematuria occurred in 1 case after RMB and there were no serious complications in all the cases. Conclusion： Percutaneous renal masses biopsy under ultrasound with a high diagnostic rate which can define the histologic subtype of renal cell carcinoma.With targeted therapy,more and more patients whose evaluation suggests local advanced disease or metastatic tumors adopt renal tumor biopsy to define the histologic subtype,which could avoid unnecessary surgical treatment.