摘要
目的 观察超声引导下经皮穿刺活检诊断胰腺实性病变的效能,探讨诊断准确率影响因素.方法 回顾性分析746例因胰腺实性病变接受经皮超声引导下粗针穿刺活检(US-CNB)患者,记录临床及影像学资料、胰腺穿刺相关资料和病理诊断;以穿刺12个月后临床随访结果为最终诊断,评估US-CNB诊断胰腺实性病变的效能.以单因素分析及logistic回归分析筛选影响US-CNB诊断准确率的因素.结果 742穿刺活检成功,技术成功率99.46％(742/746).US-CNB准确诊断706例(准确组)、不准确36例(不准确组),其诊断胰腺实性病变的敏感度、特异度、准确率、阳性预测值及阴性预测值分别为95.25％(702/737)、80.00％(4/5)、95.15％(706/742)、99.86％(702/703)和 10.26％(4/39).31 例(31/742,4.18％)发生轻度并发症,4例(4/742,0.54％)发生严重并发症.组间患者年龄,胰腺病灶最大径＜2 cm、病灶边界不清晰及病灶位于胰头部占比差异均有统计学意义(P均＜0.1).回归分析显示,病灶最大径＜2 cm是US-CNB诊断准确率的独立影响因素(OR=3.054,P=0.030).结论 超声引导下经皮胰腺病变穿刺活检安全、可靠,但病灶体积小可能影响其准确性.
Abstract
Objective To observe diagnostic efficacy of ultrasound-guided percutaneous biopsy for solid pancreatic lesions,also to explore the impact factors of diagnostic accuracy.Methods Data of 746 patients with solid pancreatic lesions underwent ultrasound-guided core needle biopsy(US-CNB)were retrospectively analyzed.Clinical data,imaging records,pancreatic puncture-related information and pathological diagnosis details were collected.After 12 months follow-up,the final clinical diagnoses were assessed,and the efficacy of US-CNB for diagnosing solid pancreatic lesions was evaluated.Univariate analysis and logistic regression analysis were used to screen impact factors for US-CNB diagnostic accuracy of solid pancreatic lesions.Results US-CNB was successfully performed in 742 cases,with the technical success rate of 99.46％(742/746).US-CNB accurately diagnosed pancreatic lesions in 706 cases(accurate group)but inaccurately judged 36 cases(inaccurate group).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of US-CNB for diagnosing solid pancreatic lesions was 95.25％(702/737),80.00％(4/5),95.15％(706/742),99.86％(702/703)and 10.26％(4/39),respectively.Mild post-procedural complications occurred in 31 cases(31/742,4.18％),while severe complications observed in 4 cases(4/742,0.54％).There were significant differences of patients'age and the ratio of lesions with the maximum diameter＜2 cm,with unclear boundaries or located in the head of pancreas between groups(all P＜0.1).Regression analysis showed that the maximum diameter of lesion＜2 cm was the independent impact factor of the accuracy of US-CNB for diagnosing solid pancreatic lesions(OR=3.054,P=0.030).Conclusion Ultrasound-guided percutaneous biopsy of solid pancreatic lesion was safe and reliable,but its accuracy might decrease in small size lesions.
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