CT引导下经皮肺穿刺活检术在外周型与中央型病变中诊断效率和并发症的比较
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摘要
目的探讨CT引导下经皮肺穿刺活检术在中央型、外周型病变中诊断效率及并发症的差异。方法回顾性分析2013年5月至2016年5月在东部战区总医院行CT引导下经皮肺穿刺活检术的417例患者,将其分为中央型组(57例)和外周型组(360例),比较2组诊断效率和并发症。结果中央型组的敏感性、特异性、诊断正确率分别为92.0%、100%、91.2%。外周型组的敏感性、特异性、诊断正确率分别为94.8%、100%、94.7%。并发症:中央型组14例(24.6%)出血,15例(26.3%)发生气胸;外周型组55例(15.3%)出血,59例(16.4%)出现气胸。2组间诊断正确率以及出血和气胸的发生率比较差异均无统计学意义(P>0. 05)。结论 CT引导下肺穿刺活检术不但在外周型病灶中具有诊断价值,在中央型病灶同样是安全、有效的诊断工具。
Objective To compare the difference in diagnostic yield and incidence of complications for CT-guided percutaneous transthoracic needle biopsy between central lesions and peripheral lesions. Methods We retrospectively analysed 417 patients who underwent CT-guided transthoracic needle biopsy during May 2013 and May 2016,57 was central lesions and 360 was peripheral lesions. Chi-square test was used. Results For central lesions lesion,the sensitivity,specificity and diagnostic yield of CT-guided needle biopsy was 92.0%,100%,91. 2%. For peripheral lesion,the sensitivity,specificity and diagnostic yield was 94.8%,100%,94.7%,respectively. Incidences of hemorrhage and pneumothorax in central lesions were 24.6% and 26.3%,which in peripheral lesions were 15.3% and 16.4%. Neither diagnostic yield nor incidences of complications,hemorrhage and pneumothorax,had significant differences between two groups( P>0. 05). Conclusion CT-guided transthoracic needle biopsy was a safe diagnostic tool not only for peripheral lesions but also for central lesions.
Objective To compare the difference in diagnostic yield and incidence of complications for CT-guided percutaneous transthoracic needle biopsy between central lesions and peripheral lesions. Methods We retrospectively analysed 417 patients who underwent CT-guided transthoracic needle biopsy during May 2013 and May 2016,57 was central lesions and 360 was peripheral lesions. Chi-square test was used. Results For central lesions lesion,the sensitivity,specificity and diagnostic yield of CT-guided needle biopsy was 92.0%,100%,91. 2%. For peripheral lesion,the sensitivity,specificity and diagnostic yield was 94.8%,100%,94.7%,respectively. Incidences of hemorrhage and pneumothorax in central lesions were 24.6% and 26.3%,which in peripheral lesions were 15.3% and 16.4%. Neither diagnostic yield nor incidences of complications,hemorrhage and pneumothorax,had significant differences between two groups( P>0. 05). Conclusion CT-guided transthoracic needle biopsy was a safe diagnostic tool not only for peripheral lesions but also for central lesions.
引文
[1]Zhan P,Zhu QQ,Miu YY,et al.Comparison between endobronchial ultrasound-guided transbronchial biopsy and CT-guided transthoracic lung biopsy for the diagnosis of peripheral lung cancer:a systematic review and meta-analysis[J].Transl Lung Cancer Res,2017,6(1):23-34.
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[11]Yin ZY,Lin ZY,Wang Y,et al.Risk Factors of Complications after CT-guided Percutaneous Needle Biopsy of Lumps Near Pulmonary Hilum[J].J Huazhong Univ Sci Technolog Med Sci,2015,35(2):278-282.
[12]Chami HA,Faraj W,Yehia ZA,et al.Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy:the role of quantitative CT[J].Clin Radiol,2015,70(12):1382-1387.
[13]Hiraki T,Mimura H,Gobara H,et al.Incidence of and risk factors for pneumothorax and chest tube placement after CT fluoroscopy-guided percutaneous lung biopsy:retrospective analysis of the procedures conducted over a 9-year period[J].AJR Am JRoentgenol,2010,194(3):809-814.
[14]黄挺,詹茜,王铁功,等.CT引导下经皮肺穿刺活检术后气胸发生的危险因素分析[J].第二军医大学学报,2017.http://kns.cnki.net/kcms/detail/31.1001.R.20171129.1125.002.html.
[15]Wang Y,Li W,He X,et al.Computed tomography-guided core needle biopsy of lung lesions:Diagnostic yield and correlation between factors and complications[J].Oncol Lett,2014,7(1):288-294.
[16]Li G,Fu Y,Cao W,et al.Computed tomography-guided percutaneous cutting needle biopsy for small(≤20 mm)lung nodules[J].Medicine,2017,96(46):e8703.
[17]Nour-Eldin NE,Alsubhi M,Naguib NN,et al.Risk factor analysis of pulmonary hemorrhage complicating CT-guided lung biopsy in coaxial and non-coaxial core biopsy techniques in 650patients[J].Eur J Radiol,2014,83(10):1945-1952.
[18]刘强,赵建龙,杨丽,等.双套管切割活检针联合康派特医用胶在肺中央型病变患者CT引导下经皮肺穿刺活检术中的可行性及安全性研究[J].实用心脑肺血管病杂志,2015,23(12):71-73.
[19]李晓光,朱海涛.CT引导下Bard Magnum穿刺切割针在肺门区肿块活检中的临床应用价值[J].中外医学研究,2014,12(17):59-60.
[2]Bhatt KM,Tandon YK,Graham R,et al.Electromagnetic Navigational Bronchoscopy versus CT-guided Percutaneous Sampling of Peripheral Indeterminate Pulmonary Nodules:A Cohort Study[J].Radiology,2018,286(3):1052-1061.
[3]孙惠玉,朴相茂,李相国,等.CT引导下经皮肺穿刺活检在中央型肺癌诊断中的应用[J].中国现代医生,2014,52(16):87-89.
[4]张鸿文,张芨,雷娟,等.CT引导下经皮肺穿刺活检在管外型中央型肺癌中的诊断价值[J].临床肺科杂志,2012,17(5):886-888.
[5]裘敏剑,高航翔,郑伟良,等.CT引导胸穿肺活检对纤支镜阴性的肺部肿块诊断价值[J].放射学实践,2003,18(2):88-90.
[6]Yao X,Gomes MM,Tsao MS,et al.Fine-needle aspiration biopsy versus core-needle biopsy in diagnosing lung cancer:a systematic review[J].Curr Oncol,2012,19(1):e16-27.
[7]Heerink WJ,de Bock GH,de Jonge GJ,et al.Complication rates of CT-guided transthoracic lung biopsy:meta-analysis[J].Eur Radiol,2017,27(1):138-148.
[8]王挺,赵振华,余月芳.CT导向下肺中央型病变穿刺活检[J].放射学实践,2010,25(11):1279-1282.
[9]Nour-Eldin NA,Alsubhi M,Emam A,et al.Pneumothorax Complicating Coaxial and Non-coaxial CT-Guided Lung Biopsy:Comparative Analysis of Determining Risk Factors and Management of Pneumothorax in a Retrospective Review of 650 Patients[J].Cardiovasc Intervent Radiol,2016,39(2):261-270.
[10]Mills M,Choi J,El-Haddad G,et al.Retrospective analysis of technical success rate and procedure-related complications of867 percutaneous CT-guided needle biopsies of lung lesions[J].Clin Radiol,2017,72(12):1038-1046.
[11]Yin ZY,Lin ZY,Wang Y,et al.Risk Factors of Complications after CT-guided Percutaneous Needle Biopsy of Lumps Near Pulmonary Hilum[J].J Huazhong Univ Sci Technolog Med Sci,2015,35(2):278-282.
[12]Chami HA,Faraj W,Yehia ZA,et al.Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy:the role of quantitative CT[J].Clin Radiol,2015,70(12):1382-1387.
[13]Hiraki T,Mimura H,Gobara H,et al.Incidence of and risk factors for pneumothorax and chest tube placement after CT fluoroscopy-guided percutaneous lung biopsy:retrospective analysis of the procedures conducted over a 9-year period[J].AJR Am JRoentgenol,2010,194(3):809-814.
[14]黄挺,詹茜,王铁功,等.CT引导下经皮肺穿刺活检术后气胸发生的危险因素分析[J].第二军医大学学报,2017.http://kns.cnki.net/kcms/detail/31.1001.R.20171129.1125.002.html.
[15]Wang Y,Li W,He X,et al.Computed tomography-guided core needle biopsy of lung lesions:Diagnostic yield and correlation between factors and complications[J].Oncol Lett,2014,7(1):288-294.
[16]Li G,Fu Y,Cao W,et al.Computed tomography-guided percutaneous cutting needle biopsy for small(≤20 mm)lung nodules[J].Medicine,2017,96(46):e8703.
[17]Nour-Eldin NE,Alsubhi M,Naguib NN,et al.Risk factor analysis of pulmonary hemorrhage complicating CT-guided lung biopsy in coaxial and non-coaxial core biopsy techniques in 650patients[J].Eur J Radiol,2014,83(10):1945-1952.
[18]刘强,赵建龙,杨丽,等.双套管切割活检针联合康派特医用胶在肺中央型病变患者CT引导下经皮肺穿刺活检术中的可行性及安全性研究[J].实用心脑肺血管病杂志,2015,23(12):71-73.
[19]李晓光,朱海涛.CT引导下Bard Magnum穿刺切割针在肺门区肿块活检中的临床应用价值[J].中外医学研究,2014,12(17):59-60.