CT引导下抽吸活检与CT引导下切割活检用于诊断胰腺占位性病变的对比研究

A comparison between CT-guided fine-needle aspiration biopsy with core-needle biopsy for pancreatic lesions

目的:探讨CT引导下抽吸活检(CT-FNA)与CT引导下切割活检(CT-CNB)在胰腺占位性病变诊断中的安全性和临床价值。方法:回顾分析郑州大学第一附属医院2017年1月至2022年1月行CT引导下经皮胰腺占位性病变穿刺活检患者的临床资料。共纳入454例患者,其中男性251例,女性203例,年龄(60.5±11.6)岁。按取材方法分为CT-FNA组(n=300)和CT-CNB组(n=154例)。比较两种活检方法的一次性诊断率、准确率、灵敏度、假阴性率及并发症情况等。结果:CT-CNB组一次性诊断率和准确率均略高于CT-FNA组,但差异无统计学意义[诊断率:92.2%(142/154)比86.0%(258/300),χ^(2)=3.74,P=0.053;准确率:97.4%(150/154)比92.0%(276/300),χ^(2)=0.16,P=0.690]。与CT-FNA组相比,CT-CNB组具有较高的灵敏度和较低的假阴性率[灵敏度:97.2%(138/142)比91.5%(260/284),χ^(2)=4.89,P=0.036;假阴性率:2.8%(4/142)比8.5%(24/284),χ^(2)=4.89,P=0.036],且差异有统计学意义。CT-FNA组和CT-CNB组常见并发症为疼痛、血肿、胰腺炎,并发症发生率两组比较差异无统计学意义[9.0%(27/300)比9.1%(14/154),χ2<0.01,P=0.975]。结论:CT-FNA与CT-CNB用于诊断胰腺占位性病变均具有较好的安全性和准确率,CT-CNB比CT-FNA具有较高的灵敏度和较低的假阴性率。

Objective To compare the safety and clinical value of percutaneous computed tomography(CT)-guided fine-needle aspiration biopsy(CT-FNA)with CT-guided core-needle biopsy(CT-CNB)in diagnosis of pancreatic lesions.Methods We retrospectively analyzed the clinical data of patients with pancreatic lesions who underwent percutaneous CT-guided biopsy from January 2017 to January 2022 at the First Affiliated Hospital of Zhengzhou University.A total of 454 patients(251 men,203 women)were enrolled in this study with age of(60.5±11.6)years old.They were divided into the CT-FNA group(n=300)and the CT-CNB group(n=154)according to the biopsy method.The one-time diagnosis rate,accuracy,sensitivity,false negative rate and incidence rate of complications of the two groups were compared.Results The one-time diagnosis rate and accuracy rate in the CT-CNB group were slightly higher than those in the CT-FNA group,but the differences were not statistically significant[92.2%(142/154)vs.86.0%(258/300),χ^(2)=3.74,P=0.053;97.4%(150/154)vs.92.0%(276/300),χ^(2)=0.16,P=0.690].Compared with the CT-FNA group,the CT-CNB group had a higher sensitivity and a lower false negative rate,and the differences were statistically significant[97.2%(138/142)vs.91.5%(260/284),χ^(2)=4.89,P=0.036;2.8%(4/142)vs.8.5%(24/284),χ^(2)=4.89,P=0.036].Common complications in the two groups were pain,hematoma and pancreatitis,and there was no statistically significant difference in the incidences of complication[9.0%(27/300)vs.9.1%(14/154),χ2<0.01,P=0.975].Conclusions Both CT-FNA and CT-CNB were safe for diagnosis of pancreatic lesions,with high diagnostic yields and with similar safety and accuracy.When compared with CT-FNA,CT-CNB has a higher sensitivity and a lower false negative rate.