Objective: To compare the safety and diagnostic efficiency of CT-guided trans-organ and non-trans-organ large needle biopsy in the diagnosis of pancreatic space-occupying lesions. Methods: The clinical data of 367 patients with pancreatic mass who underwent CT-guided percutaneous biopsy in the First Affiliated Hospital of Zhengzhou University from January 2019 to January 2022 were retrospectively analyzed, including 211 males and 156 females, aged 18 to 87 (60.7±11.8) years old. They were divided into a trans-organ route group (n=142) and a non-trans-organ route group (n=225) according to whether traversing the organs during the procedures. The imaging data, pathological results, puncture process and complications of patients of the two groups were recorded. The successful rate for obtaining tissue,one-time successful diagnosis rate, accuracy, sensitivity, specificity, false negative rate and the incidence of complications were compared between the two groups. Results: There was no significant difference in baseline data between the two groups (all P>0.05).There were 28, 57, 24, and 33 biopsies were performed via a pathway traversing liver, stomach, small bowel and colon, respectively. The overall sampling success rates of the two groups were 100%.The one-time successful diagnosis rate did not show statistically difference between the two groups [86.6%(123/142) vs 87.1%(196/225),P=0.892]. There was no statistically difference in accuracy, sensitivity and false negative rates between trans-organ route group and non-trans-organ routegroup [92.3%(131/142) vs 92.0%(207/225), 91.8% (123/134) vs 90.0%(190/211) and 8.2% (11/134) vs 10.0%(21/211), all P>0.05]. The specificity was 100% in both groups. The common complications of the two groups were increased pancreatic amylase and hematoma, and there was no significant difference in the incidence of complications between the trans-organ route group and the non-trans-organ route group [10.6% (15/142) vs 12.4% (28/225), P=0.585]. In the trans-organ route group, 5 patients had increased pancreatic amylase and 10 patients had local hematoma, all of which were improved after conservative treatment. In the non-organ route group, 11 patients had elevated pancreatic amylase, and 17 patients had local hematoma, 1 case received surgical treatment due to bleeding, the rest were improved by conservative treatment. Conclusion: CT-guided percutaneous transabdominal organ large needle biopsy of pancreatic space-occupying lesions has the comparable diagnostic efficiency and safety as non-transabdominal organ approach.
目的： 对比CT引导经脏器路径和非经脏器路径粗针穿刺活检诊断胰腺占位性病变的安全性及诊断效能。 方法： 回顾性分析2019年1月至2022年1月郑州大学第一附属医院367例接受CT引导经皮穿刺活检的胰腺占位患者的临床资料，其中男211例，女156例，年龄18~87（60.7±11.8）岁。以术中是否经脏器分为经脏器路径组（142例）和非经脏器路径组（225例）。记录2组患者影像资料、病理结果、穿刺过程和并发症等，对比分析2组取材成功率、一次性诊断率、准确率、灵敏度、特异度、假阴性率及并发症发生率。 结果： 2组患者基线资料差异无统计学意义（均P>0.05）。经脏器路径组有患者28例经肝、57例经胃、24例经小肠、33例经结肠。2组取材成功率均为100%，2组一次性诊断成功率差异无统计学意义［86.6%（123/142）比87.1%（196/225），P=0.892］；经脏器路径组和非经脏器路径组的诊断准确率、灵敏度和假阴性率差异均无统计学意义［92.3%（131/142）比92.0%（207/225）、91.8%（123/134）比90.0%（190/211）和8.2%（11/134）比10.0%（21/211），均P>0.05］。2组特异度均为100%。2组常见并发症为胰淀粉酶升高和血肿，经脏器路径组和非经脏器路径组并发症发生率差异无统计学意义［10.6%（15/142）比12.4%（28/225），P=0.585］。经脏器路径组有5例患者出现胰淀粉酶升高、10例患者出现局部血肿，均经保守治疗好转；非经脏器路径组有11例患者出现胰淀粉酶升高、17例患者局部血肿，1例因出血接受手术治疗，剩余均经保守治疗好转。 结论： CT引导经皮经腹腔脏器进行胰腺占位性病变粗针穿刺活检与非经腹腔脏器路径具有相同的诊断效能和安全性。.