骨破坏性病变细针穿刺活检病理诊断临床价值探讨

Value of fine needle aspiration biopsy pathology on destructive bone lesions

目的细针穿刺活检(fine needle aspiration biopsy,FNAB)是一种有效的、侵袭性小、价廉的诊断方法。本研究旨在探讨FNAB对常见骨破坏性病变的诊断价值。方法回顾性分析聊城市第二人民医院2005-05-01-2017-06-30收治的133例常见骨破坏性病变病例,术前直接经皮或在CT、X射线和超声引导下行FNAB病理检查,并与术后或组织活检病理诊断作对比。观察分析其细针穿刺细胞学(fine needle aspiration cytology,FNAC)和细胞块切片的形态学特点(包括免疫组化标记结果)及诊断准确率。结果 FNAC及联合细胞块定性诊断准确率均显示较高,其敏感度分别为89.9%(80/89)和91.0%(81/89),特异度分别为90.9%(40/44)和93.2%(41/44),总准确率分别为90.2%(120/133)和91.7%(122/133),二者比较差异无统计学意义,χ~2=0.183,P=0.669;FNAC和FNAB对良性/中间性病变分类诊断准确率分别为68.2%(30/44)和93.2%(41/44),χ~2=8.822,P=0.003;恶性病变分类诊断准确率分别为69.7%(62/89)和87.6%(78/89),χ~2=8.565,P=0.003。对良/中间性和恶性病变的分类诊断准确率比较,差异均有统计学意义。对转移癌的分类诊断准确率分别为72.4%(21/29)和96.6%(28/29),差异有统计学意义,χ~2=6.444,P=0.011。结论 FNAB较FNAC具有较高的分类诊断准确率,是骨破坏性病变术前诊断的有效方法。

OBJECTIVE Fine needle aspiration biopsy（FNAB）is an effective,minimally-invasive,inexpensive,diagnostic technique.The objective of this study was to evaluate the accuracy of FNAB in the diagnosis of bone lesions on destructive bone lesions.METHODS The clinical data of 133 cases of osteolytic or destructive bone lesions that hospitalized in Liaocheng Second People＇s Hospital from May 1,2005 to June 30,2017 were retrospectively analyzed.FNABs were performed preoperatively percutaneously or under CT,X-ray or ultrasound guidance then the results diagnosed by FNAB were compared with postoperative or biopsy pathological diagnosis.The morphological features（including immunohistochemistry）and diagnostic accuracy were observed and analyzed in the fine needle aspiration cytology（FNAC）and cell block（CB）.RESULTS The qualitative diagnostic accuracy of FNAC and CB were all high,with the sensitivity of 89.9%（80/89）and 91.0%（81/89）,the specificity of 90.9%（40/44）and 93.2%（41/44）.The overall qualitative accuracy of the two methods was 90.2%（120/133）and 91.7%（122/133）,respectively,there was no significant difference between them（χ^2=0.183,P=0.669）.Fore classification diagnostic accuracy rates of benign/intermediate lesions were 68.2%（30/44）and93.2%（41/44,χ^2=8.822,P=0.003）.The classification diagnostic accuracy rates of malignant lesions were 69.7%（62/89）and 87.6%（78/89,χ^2=8.565,P=0.003）.There were significant differences between these two methods in classification diagnostic accuracy of benign/intermediate and malignant.There was also a significant difference between them in the accuracy of classification diagnostic of metastatic cancer（χ^2=6.444,P=0.011）.CONCLUSION FNAB with high classification diagnostic accuracy compaired with FNAC is an effective method for preoperative diagnosis of destructive bone lesions.