Ultrason Kılavuzluğunda Omental Biyopsinin Diagnstik Doğruluğu ve Güvenliği : Tek Merkez Sonuçları

Year 2023, , 365 - 369, 30.06.2023

Özgür Özen , Tolga Zeydanlı , Batuhan Kirisci , Emre Karakaya

https://doi.org/10.18663/tjcl.1298731

Abstract

Amaç: Omental biyopsi geleneksel olarak cerrahi bir yaklaşım kullanılarak yapılmaktadır. Kalınlaşmış omentum, klinik pratikte tanı koyulabilmesi için ultrasonografi eşliğinde perkütan biyopsi yapılabilir bir hedeftir. Çalışmamızın amacı, omental kalınlaşmanın ultrason eşliğinde perkütan biyopsisinin tanısal doğruluğunu ve güvenliğini incelemektir. Ek olarak, biyopsi sonuçlarının parasentez sıvısı sitolojisi ile ilişkisini araştırmayı amaçlıyoruz.
Gereç ve Yöntemler: Bu retrospektif çalışma, 2014-2022 yılları arasında ultrasonun kılavuz olarak kullanıldığı omental biyopsi yapılan 49 hastayı (33 kadın ve 16 erkek; ortalama yaş, 64 ± 13.9 [SD] yıl) içermektedir. Hastaların biyopsi sonrası klinik takip ve patoloji sonuçları değerlendirilmiştir. Ayrıca kor biyopsi ve parasentez sıvı sitolojisi sonuçlarını karşılaştırılmıştır.
Bulgular: Çalışmamıza toplam 49 hasta dahil edildi. Ultrason kılavuzluğunda biyopsi hastaların 49 hastanın 46’sında (%93,8) tanı koydurucuydu. Toplam 36 (%73,4) malign olgu v, 5 (%10,2) tüberkülozu düşündüren kronik inflamasyon, 2 (%4,1) kronik periton enfeksiyonu vardı. 3 hastada kor biyopsi sonucu benign idi ve bunlar; Ig4 ilişkili inflamatuar psödotümör, desmoid fibromatoz ve yağ nekrozu-yabancı cisim reaksiyonu olarak rapor edildi. 36 malign vakanın 17'sinde (%47,2) ovaryen kanser olarak raporlandı. İşlemlerin hiçbirinde yakın dönem majör komplikasyon görülmedi. Parasentez sıvı örneklemesi yapılan 25 hastanın 21'inde (%84) sitoloji sonuçları (malign veya benign sitoloji) omental biyopsi sonuçları ile uyumlu bulundu. Sitolojik değerlendirmede 25 hastanın 16’sı (%64) malign sitoloji olarak raporlandı.

Sonuç: Ultrason eşliğinde perkütan omentum biyopsisi daha ucuz, güvenli ve etkili, tanısal doğruluğu yüksek bir yöntemdir. Omentum kalınlaşması olan hastalarda parasentez sıvısı sitolojisi sonuçları oldukça duyarlıdır.

Keywords

Biyopsi, Ultrasonografi, Omental kalınlaşma

Diagnostic Accuracy and Safety of Ultrasound Guided Omental Biopsy: Single Center Experience

Abstract

Aim: Omental biopsy has conventionally been performed using a surgical approach. The thickened omentum can serve as a useful target for ultrasonography guided percutaneous biopsy, in clinical practice. The objective of our study was to determine the diagnostic value and safety of ultrasound guided percutaneous biopsy of omental thickening. Additionally, we aim to investigate the correlation of biopsy results with the paracentesis fluid cytology.
Methods: This retrospective study included 49 patients (33 women and 16 men; mean age, 64 ± 13.9 [SD] years) who underwent ultrasound guided omental biopsy between 2014 and 2022 at a single institution at which US served as the first-line modality for omental biopsy guidance. Post-biopsy clinical follow-up were reviewed for each patient. We compare the outcomes of biopsy and paracentesis fluid cytology results.
Results: Total 49 patients were included in our study. US-guided biopsy was diagnostic in 46/49 (93.8%) of patients. There were total 36 (73.4%) malignant cases, 5 (10.2%) chronic inflammation suggestive of tuberculosis, while 2 (4.1%) were chronic peritoneal infection. In 3 patients, the result of core biopsy was benign and reported as Ig4-related inflammatory pseudotumor, desmoid fibromatosis and fat necrosis-foreign body reaction. Out of 36 malignant cases, majority 17 (47.2%) had ovarian cancer. There were no major complications. In 21 of 25 patients (%84) who underwent paracentesis fluid sampling, cytology results (malign or bening cytology) were found to be consistent with omental biopsy results. The ascitic cytological evaluation was favourable for malignancy in 16/25 (64%) patients.

Conclusions: Ultrasound-guided percutaneous biopsy of omentum is less expensive, safe and effective method with a high diagnostic accuracy. Paracentesis fluid cytology results are highly sensitive in patients with omental thickening.

Keywords

Biopsy, Ultrasonography, Omental thickening

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