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目的探讨超声造影指导肝肿瘤经皮穿刺活检的临床应用价值。方法北京大学临床肿瘤学院超声科就诊的性质不明的211例肝占位病变随机分为两组,其中96例149灶应用超声造影剂SonoVue行超声造影后采用常规超声引导穿刺活检(CEUS组),115例153灶未行超声造影只采用超声引导穿刺活检(US组)。男129例、女82例;年龄16~81岁,平均53.4岁。两组病灶大小分布差异无统计学意义(P>0.05)。其中≤2.0cm微小恶性肿瘤计67例75灶(24.8%),CEUS组、US组各占12.9%、11.9%。采用21~18G针手动抽吸活检针或自动活检针穿刺活检,取材量满足病理诊断为取材成功;活检病理诊断结果结合手术、增强CT、磁共振成像(MRI)、血管造影术、甲胎蛋白(AFP)检查或临床随访3~6个月等方法紧密随诊,分析对比两组穿刺活检结果。结果穿刺≤2次即获较满意标本者CEUS组明显多于US组(P=0.0007)。CEUS组149灶取材成功率为98.7%(n=147),确诊率为96.0%(n=143);US组153灶分别为91.5%(n=140)、87.6%(n=134)(两组比较分别P=0.0096、P=0.0165),差异有统计学意义。≤2.0cm微小恶性肿瘤的确诊率CEUS组(97.4%)明显高于US组(80.6%,P=0.0473)。此外,US组恶性肿瘤112灶中15灶(13.4%)穿刺活检阴性,经超声造影指导再次活检,14个灶被确认恶性,其中7灶≤2.0cm。除US组发生1例气胸外,余无一例并发症。结论超声造影指导穿刺活检,有助于判断恶性病变及微小肿瘤,并确认坏死及液化区,使定位取材比常规超声更准确,从而大大提高了经皮穿刺活检的成功率和恶性病变的确诊率,明显降低穿刺活检的假阴性率,具有重要临床应用价值。
Objective To investigate the clinical value of ultrasound-guided percutaneous biopsy of liver tumors. Methods Totally 211 cases of liver lesions with unknown characteristics treated by Department of Ultrasound, School of Clinical Oncology, Peking University were randomly divided into two groups. Among them, 96 cases of 149 lesions were treated with SonoVue ultrasound contrast-enhanced ultrasound-guided needle biopsy (CEUS) 115 cases of 153 cases without ultrasound contrast ultrasound only guided biopsy (US group). 129 males and 82 females; aged 16 to 81 years, an average of 53.4 years old. There was no significant difference in size distribution between the two groups (P> 0.05). Among them, 67 cases (24.8%) of 67 cases (≤2.8cm) were malignant tumor, accounting for 12.9% and 11.9% in CEUS group and US group respectively. Using 21 ~ 18G needle aspiration biopsy needle or automatic biopsy needle biopsy, the amount of material to meet the pathological diagnosis of successful drawing; biopsy pathological diagnosis combined with surgery, enhanced CT, magnetic resonance imaging (MRI), angiography, alpha fetoprotein (AFP) or clinical follow-up of 3 to 6 months and other methods closely followed, analysis and comparison of two sets of biopsy results. Results CEPS group was significantly more than the US group (P = 0.0007). In the CEUS group, the success rate of smear in 149 cases was 98.7% (n = 147) and the diagnosis rate was 96.0% (n = 143). In the US group, 153 cases were 91.5% (n = 140) and 87.6% Group P = 0.0096 respectively, P = 0.0165), the difference was statistically significant. The diagnosis rate of malignant tumors ≤ 2.0cm was significantly higher in the CEUS group (97.4%) than in the US group (80.6%, P = 0.0473). In addition, biopsies of 15 lesions (13.4%) of 112 malignant tumors in the US group were negative, followed by biopsy under the guidance of contrast-enhanced ultrasound. Fourteen lesions were confirmed to be malignant, of which 7 lesions were ≤2.0 cm. In addition to the US group occurred in 1 case of pneumothorax, I have no other complications. Conclusions Ultrasound-guided biopsy can be helpful in judging malignant lesions and tiny tumors, and confirming the necrosis and liquefaction area, making positioning and drawing more accurate than conventional ultrasound, thus greatly improving the success rate of percutaneous biopsy and the diagnosis rate of malignant lesions , Significantly reducing the false negative rate of biopsy, has important clinical value.