384例立体定向脑活检术诊断率的影响因素分析

目的探讨影响立体定向脑活检术诊断率的主要因素。方法回顾性分析384例立体定向脑活检手术的临床资料,归纳其临床特征和病理诊断,分析影响活检诊断率的主要因素,以及二次活检的诊断情况。结果本组病例中男性231例,女性153例,中位年龄47岁。197例病灶位于脑叶,134例位于幕上深部,53例位于幕下。184例病灶位于左侧,200例病灶位于右侧。深层病灶321例,浅层病灶63例。单个病灶251例,多个病灶133例。病灶体积中位数11.27cm^3。286例病灶明显强化,98例为非强化病灶。首次立体定向活检诊断率为90.9%。多因素分析结果显示＂病灶强化＂为诊断率的主要影响因素（P=0.005）,OR值为2.740。未确诊病例中8例进行二次活检,其中7例获得明确病理诊断。结论病灶强化与否是影响立体定向活检诊断率的主要因素,非强化病灶的诊断率较低。对未确诊病例进行二次活检手术有助于提高诊断水平。

Factors affecting diagnostic yield of stereotactic brain biopsy in 384 cases

Objective To analyze the factors affecting diagnostic yield in stereotactic brain biopsy.Methods Clinical data of 384 cases with brain lesions underwent stereotactic biopsy were retrospectively summarized.Clinical characteristics,pathological diagnosis,factors affecting diagnostic yield,and results of second biopsy were analyzed.Results There were 231 male cases and153 female cases.The median age was 47 years.The lesions＇ location in these cases included 197 lobar,134deep-seated,and 53 infratentorial.Th ere were 184 left side lesions and 200 right side lesions.The depths of targets consisted of 321 deep lesions and 63 superficial lesions.There were251 single lesions and 133 multiple lesions.The median volume was 11.27cm^3.286 cases had enhanced lesions and 98 cases had non-enhanced lesions.The diagnostic yield of first stereotactic biopsy was 90.9%.Multivariate analysis showed＂the enhancement＂as the main factors affecting the diagnosis yield（P=0.005）,the odds ratio was 2.740.Seven eighths non-diagnostic cases underwent the second biopsy obtained definite pathological diagnosis.Conclusion The main factors affecting diagnostic yield is the enhancement,non-enhancing lesions＇ diagnosis yield is lower.Second biopsy is helpful to improve diagnosis in non-diagnostic cases.