대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제82권5호
  • /
  • Pages.1207-1217
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  • 2021
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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주요 혈관 근처의 췌장 또는 췌장 주위 병변에 대한 초음파 유도하 경피적 중심 바늘 생검의 안전성과 효율성

Safety and Efficacy of Ultrasound-Guided Percutaneous Core Needle Biopsy of Pancreatic and Peripancreatic Lesions Adjacent to Critical Vessels

  • 정선화 (이화여자대학교 의과대학 부속 이대목동병원 영상의학과) ;
  • 강현지 (이화여자대학교 의과대학 부속 이대목동병원 영상의학과) ;
  • 이효정 (이화여자대학교 의과대학 부속 이대목동병원 영상의학과) ;
  • 김진실 (이화여자대학교 의과대학 부속 이대목동병원 영상의학과) ;
  • 이정경 (이화여자대학교 의과대학 부속 이대목동병원 영상의학과)
  • Sun Hwa Chung (Department of Radiology, Ewha Womans University College of Medicine, Ewha Womans University Mokdong Hospital) ;
  • Hyun Ji Kang (Department of Radiology, Ewha Womans University College of Medicine, Ewha Womans University Mokdong Hospital) ;
  • Hyo Jeong Lee (Department of Radiology, Ewha Womans University College of Medicine, Ewha Womans University Mokdong Hospital) ;
  • Jin Sil Kim (Department of Radiology, Ewha Womans University College of Medicine, Ewha Womans University Mokdong Hospital) ;
  • Jeong Kyong Lee (Department of Radiology, Ewha Womans University College of Medicine, Ewha Womans University Mokdong Hospital)
  • 투고 : 2020.09.03
  • 심사 : 2020.11.12
  • 발행 : 2021.09.01
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초록

목적 췌장 및 췌장 주위의 주요 혈관에 인접한 병변에 대하여 초음파 유도하 경피적 중심 바늘 생검(ultrasound-guided percutaneous core needle biopsy; 이하 USPCB)의 안전성과 효능을 평가하였다. 대상과 방법 10년 동안 췌장(n = 98), 간문맥 근처 췌장 주위(n = 34), 또는 췌장 갈고리돌기 부위와 십이지장 제3부분과 인접한 대동맥주위(n = 30) 병변에 대하여 USPCB를 시행받은 162명의 환자의 검사 결과를 수집하였다. 초음파 유도하18게이지 바늘을 가진 자동 생검 총을 사용하였고, USPCB 결과는 수술 결과 또는 추적 관찰 영상과 비교하였다. USPCB의 진단 정확도 및 주요 합병증 비율을 계산했으며, 성공적인 생검의 예측을 위한 요인이 무엇인지 단변량 및 다변량 분석을 사용하여 평가하였다. 결과 USPCB에서 조직 병리학 진단은 149명(92%) 환자에서 일치했다. 주요 합병증은 장간막 혈종 4건과 십이지장 벽내혈종 1건이 발생했다(3%). 성공적인 생검을 위한 요인으로는 위 또는 장관을 통과하는 경로보다는 경장간막 경로를 이용할수록, 초음파상 표적 및 생검 경로가 잘 보일수록 등이 포함되었다. 또한 결과적으로 생검에 성공한 경우 생검 횟수가 더 적었다. 결론 USPCB는 주요 혈관에 인접한 췌장 및 간문맥 근처 췌장 주위 병변 또는 췌장 갈고리돌기 부위나 십이지장 제3부분과 인접한 대동맥 주위 병변의 조직학적 진단을 위한 높은 정확도 및 낮은 합병증 비율을 나타냈다.

Purpose To evaluate the safety and efficacy of ultrasound-guided percutaneous core needle biopsy (USPCB) of pancreatic and peripancreatic lesions adjacent to critical vessels. Materials and Methods Data were collected retrospectively from 162 patients who underwent USPCB of the pancreas (n = 98), the peripancreatic area adjacent to the portal vein, the paraaortic area adjacent to pancreatic uncinate (n = 34), and lesions on the third duodenal portion (n = 30) during a 10-year period. An automated biopsy gun with an 18-gauge needle was used for biopsies under US guidance. The USPCB results were compared with those of the final follow-up imaging performed postoperatively. The diagnostic accuracy and major complication rate of the USPCB were calculated. Multiple factors were evaluated for the prediction of successful biopsies using univariate and multivariate analyses. Results The histopathologic diagnosis from USPCB was correct in 149 (92%) patients. The major complication rate was 3%. Four cases of mesenteric hematomas and one intramural hematoma of the duodenum occurred during the study period. The following factors were significantly associated with successful biopsies: a transmesenteric biopsy route rather than a transgastric or transenteric route; good visualization of targets; and evaluation of the entire US pathway. In addition, the number of biopsies required was less when the biopsy was successful. Conclusion USPCB demonstrated high diagnostic accuracy and a low complication rate for the histopathologic diagnosis of pancreatic and peripancreatic lesions adjacent to critical vessels.

키워드

참고문헌

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