实时超声引导下经皮穿刺活检在肺周围型肿块诊断中的临床价值
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摘要
目的:评价实时超声引导下经皮穿刺活检对肺周围型肿块诊断的准确性。方法:本文回顾了130例肺周围型肿块患者的组织病理学结果、临床记录和手术过程。通过对活检过程的分析,评估影响诊断准确性的因素,分为真阳性、真阴性、假阳性、假阴性、不确定。采用人口学相关因素的统计分析其病变特征和活检细节,以确定其对诊断准确性产生的可能影响。结果:在130例肺周围型肿块患者中,恶性病变48例,良性病变57例,25例病灶不确定。在57例良性病变中,21例为结核性的。总体诊断准确率为88.5%,≤20 mm、21～49 mm和≥50 mm诊断准确度分别为81.5%、92.6%、85.7%,而敏感度分别为75.0%、90.3%、88.0%,而特异度均为100%。16例(12.3%)患者发生并发症,咯血、症状性气胸、插胸管、穿刺部位疼痛发生率分别为7.7%(10例)、1.5%(2例)、0.8%(1例)、2.3%(3例)。结论:超声引导经皮穿刺活检对肺周围型肿块诊断是一种有效、安全的诊断方法,诊断准确性受肿块大小的影响。
Objective:To evaluate the clinical value of real-time ultrasound-guided percutaneous biopsy in the diagnosis of pulmonary peripheral mass.Method:A retrospective study on histopathology,clinical condition and surgery condition was performed in 130 cases of pulmonary peripheral mass.Based on the analysis of the biopsy process,the factors affecting the diagnostic accuracy were evaluated,including true positive,true negative,false positive,false negative and uncertain.The characteristics of lesions and biopsy details were analyzed by demographic correlation factors to determine the possible impact on diagnostic accuracy.Result:There were48 malignant,57 benign and 25 indeterminate in 130 cases.21 of 57 benign cases was tuberculous.The total diagnostic accuracy was 88.5% and its of ≤20 mm,21-49 mm and ≥50 mm mass were 81.5%、92.6%、85.7%respectively.The sensitivity for ≤20 mm,21-49 mm and ≥50 mm mass were 75.0%,90.3% and 88.0%,the specificity of all masses were 100%.16 patients(12.3%)had complications,including hemoptysis(10 cases,7.7%),symptomatic pneumothorax(2 cases,1.5%),tubal thoracostomy(1 case,0.8%)and the puncture site pain(3 cases,2.3%).Conclusion:Ultrasound-guided percutaneous biopsy is an effective and safe method for the diagnosis of pulmonary peripheral mass,and its accuracy depends on the size of mass.
Objective:To evaluate the clinical value of real-time ultrasound-guided percutaneous biopsy in the diagnosis of pulmonary peripheral mass.Method:A retrospective study on histopathology,clinical condition and surgery condition was performed in 130 cases of pulmonary peripheral mass.Based on the analysis of the biopsy process,the factors affecting the diagnostic accuracy were evaluated,including true positive,true negative,false positive,false negative and uncertain.The characteristics of lesions and biopsy details were analyzed by demographic correlation factors to determine the possible impact on diagnostic accuracy.Result:There were48 malignant,57 benign and 25 indeterminate in 130 cases.21 of 57 benign cases was tuberculous.The total diagnostic accuracy was 88.5% and its of ≤20 mm,21-49 mm and ≥50 mm mass were 81.5%、92.6%、85.7%respectively.The sensitivity for ≤20 mm,21-49 mm and ≥50 mm mass were 75.0%,90.3% and 88.0%,the specificity of all masses were 100%.16 patients(12.3%)had complications,including hemoptysis(10 cases,7.7%),symptomatic pneumothorax(2 cases,1.5%),tubal thoracostomy(1 case,0.8%)and the puncture site pain(3 cases,2.3%).Conclusion:Ultrasound-guided percutaneous biopsy is an effective and safe method for the diagnosis of pulmonary peripheral mass,and its accuracy depends on the size of mass.
引文
[1]Shepherd R W.Bronchoscopic pursuit of the peripheral pulmonary lesions:Navigational bronchoscopy,radial endobronchial ultrasound,and ultrathin bronchoscopy[J].Curr Opin Pulm Med,2016,22(3):257-264.
[2]杨静茹.B超引导下肺穿刺活检诊断肺周围病灶的临床价值分析[J].河北医学,2015,21(4):608-610.
[3]Majid A,Palkar A,Kheir F,et al.Convex Probe EBUS-guided Fiducial Placement for Malignant Central Lung Lesions[J].J Bronchology Interv Pulmonol,2018,25(4):283-289.
[4]李凤,黄伟俊,彭巍炜,等.影像融合导航技术与超声引导下经皮肺穿刺活检的应用比较[J].广东医学,2018,39(S2):144-146.
[5]Lim H J,Park C M,Yoon S H,et al.Cone-Beam CT Virtual Navigation-Guided Percutaneous Needle Biopsy of Suspicious Pleural Metastasis:A Pilot Study[J].Korean J Radiol,2018,19(5):872-879.
[6]Fiore L,Frenk N E,Martins G L P,et al.Systemic Air Embolism after Percutaneous Lung Biopsy:A Manageable Complication[J].J Radiol Case Rep,2017,11(6):6-14.
[7]刘静,黄鑫,袁爽,等.超声造影在周围型肺及胸膜肿块病变诊断和穿刺活检中的应用价值[J].武汉大学学报(医学版),2017,38(1):57-60.
[8]Deng C J,Dai F Q,Qian K,et al.Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review[J].BMCPulm Med,2018,18(1):146.
[9]Lucidarme O,Howarth N,Finet J F,et al.Intrapulmonary lesions:Percutaneous automated biopsy with a detachable,18-gauge,coaxial needle[J].Radiology,1998,207(3):759-765.
[10]黎秋,时彩红.超声引导经皮肺穿刺活检诊断肺周围型占位性病变的临床价值[J].广西医学,2018,40(1):97-101.
[11]Kang T W,Lee M W,Song K D,et al.Added Value of Contrast-Enhanced Ultrasound on Biopsies of Focal Hepatic Lesions Invisible on Fusion Imaging Guidance[J].Korean JRadiol,2017,18(1):152-161.
[12]Ahn S J,Lee J M,Chang W,et al.Clinical utility of realtime ultrasound-multimodality fusion guidance for percutaneous biopsy of focal liver lesions[J].Eur J Radiol,2018,103:76-83.
[13]Francica G,Meloni M F,de Sio I,et al.Biopsy of Liver Target Lesions under Contrast-Enhanced Ultrasound Guidance-AMulti-Center Study[J].Ultraschall Med,2018,39(4):448-453.
[14]Hu Y,Kasivisvanathan V,Simmons L A,et al.Development and Phantom Validation of a 3-D-Ultrasound-Guided System for Targeting MRI-Visible Lesions During Transrectal Prostate Biopsy[J].IEEE Trans Biomed Eng,2017,64(4):946-958.
[15]Yeow K M,See L C,Lui K W,et al.Risk factors for pneumothorax and bleeding after CT-guided percutaneous coaxial cutting needle biopsy of lung lesions[J].J Vasc Interv Radiol,2001,12(11):1305-1331.
[16]Radtke J P,Teber D,Hohenfellner M,et al.The current and future role of magnetic resonance imaging in prostate cancer detection and management[J].Transl Androl Urol,2015,4(3):326-341.
[17]van de Ven W J,Sedelaar J P,van der Leest M M,et al.Visibility of prostate cancer on transrectal ultrasound during fusion with multiparametric magnetic resonance imaging for biopsy[J].Clin Imaging,2016,40(4):745-750.
[18]Lahiff C,Mun Wang L,Travis S P L,et al.Diagnostic Yield of Dysplasia in Polyp-adjacent Biopsies for Patients with Inflammatory Bowel Disease:A Cross-sectional Study[J].J Crohns Colitis,2018,12(6):670-676.
[19]代睿,冯蕾,孙琰,等.超声造影引导肺周围型局灶性病变活检20例[J].昆明医科大学学报,2015,36(6):158-159.
[20]Yang B R,Kim H J,Shin K M,et al.Serial Ultrasound Findings After Laser Ablation for Benign Breast Lesions on LongTerm Follow-Up:Implications for Evaluation of Procedural Success[J].Photomed Laser Surg,2015,33(8):404-408.
[2]杨静茹.B超引导下肺穿刺活检诊断肺周围病灶的临床价值分析[J].河北医学,2015,21(4):608-610.
[3]Majid A,Palkar A,Kheir F,et al.Convex Probe EBUS-guided Fiducial Placement for Malignant Central Lung Lesions[J].J Bronchology Interv Pulmonol,2018,25(4):283-289.
[4]李凤,黄伟俊,彭巍炜,等.影像融合导航技术与超声引导下经皮肺穿刺活检的应用比较[J].广东医学,2018,39(S2):144-146.
[5]Lim H J,Park C M,Yoon S H,et al.Cone-Beam CT Virtual Navigation-Guided Percutaneous Needle Biopsy of Suspicious Pleural Metastasis:A Pilot Study[J].Korean J Radiol,2018,19(5):872-879.
[6]Fiore L,Frenk N E,Martins G L P,et al.Systemic Air Embolism after Percutaneous Lung Biopsy:A Manageable Complication[J].J Radiol Case Rep,2017,11(6):6-14.
[7]刘静,黄鑫,袁爽,等.超声造影在周围型肺及胸膜肿块病变诊断和穿刺活检中的应用价值[J].武汉大学学报(医学版),2017,38(1):57-60.
[8]Deng C J,Dai F Q,Qian K,et al.Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review[J].BMCPulm Med,2018,18(1):146.
[9]Lucidarme O,Howarth N,Finet J F,et al.Intrapulmonary lesions:Percutaneous automated biopsy with a detachable,18-gauge,coaxial needle[J].Radiology,1998,207(3):759-765.
[10]黎秋,时彩红.超声引导经皮肺穿刺活检诊断肺周围型占位性病变的临床价值[J].广西医学,2018,40(1):97-101.
[11]Kang T W,Lee M W,Song K D,et al.Added Value of Contrast-Enhanced Ultrasound on Biopsies of Focal Hepatic Lesions Invisible on Fusion Imaging Guidance[J].Korean JRadiol,2017,18(1):152-161.
[12]Ahn S J,Lee J M,Chang W,et al.Clinical utility of realtime ultrasound-multimodality fusion guidance for percutaneous biopsy of focal liver lesions[J].Eur J Radiol,2018,103:76-83.
[13]Francica G,Meloni M F,de Sio I,et al.Biopsy of Liver Target Lesions under Contrast-Enhanced Ultrasound Guidance-AMulti-Center Study[J].Ultraschall Med,2018,39(4):448-453.
[14]Hu Y,Kasivisvanathan V,Simmons L A,et al.Development and Phantom Validation of a 3-D-Ultrasound-Guided System for Targeting MRI-Visible Lesions During Transrectal Prostate Biopsy[J].IEEE Trans Biomed Eng,2017,64(4):946-958.
[15]Yeow K M,See L C,Lui K W,et al.Risk factors for pneumothorax and bleeding after CT-guided percutaneous coaxial cutting needle biopsy of lung lesions[J].J Vasc Interv Radiol,2001,12(11):1305-1331.
[16]Radtke J P,Teber D,Hohenfellner M,et al.The current and future role of magnetic resonance imaging in prostate cancer detection and management[J].Transl Androl Urol,2015,4(3):326-341.
[17]van de Ven W J,Sedelaar J P,van der Leest M M,et al.Visibility of prostate cancer on transrectal ultrasound during fusion with multiparametric magnetic resonance imaging for biopsy[J].Clin Imaging,2016,40(4):745-750.
[18]Lahiff C,Mun Wang L,Travis S P L,et al.Diagnostic Yield of Dysplasia in Polyp-adjacent Biopsies for Patients with Inflammatory Bowel Disease:A Cross-sectional Study[J].J Crohns Colitis,2018,12(6):670-676.
[19]代睿,冯蕾,孙琰,等.超声造影引导肺周围型局灶性病变活检20例[J].昆明医科大学学报,2015,36(6):158-159.
[20]Yang B R,Kim H J,Shin K M,et al.Serial Ultrasound Findings After Laser Ablation for Benign Breast Lesions on LongTerm Follow-Up:Implications for Evaluation of Procedural Success[J].Photomed Laser Surg,2015,33(8):404-408.