CT引导下经皮穿刺活检对肺小结节的诊断价值
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摘要
目的探讨CT引导下肺小结节经皮穿刺活检的准确性和临床应用价值。方法回顾性分析2015年1月至2017年12月75例在南京医科大学附属肿瘤医院进行CT引导下经皮肺小结节(长径≤1 cm)穿刺活检术的患者资料,其中65例使用针吸活检,10例使用切割活检。分析两种方法的诊断敏感度和准确率,以及常见并发症的发生率。结果两组的穿刺成功率均为100%;针吸活检组的敏感度和准确率为71.4%(35/49)和72.3%(47/65),切割活检组为85.7%(6/7)和80.0%(8/10),两种方法之间差异无统计学意义(P>0.05)。切割活检组邻近肺野出血发生率25.0%,高于针吸活检组的4.3%,差异有统计学意义(P<0.05);切割活检组的气胸、针道渗血及胸膜下血肿发生率分别为50.0%、41.7%、16.7%,针吸活检组为24.6%、47.8%、1.4%,两组间差异均无统计学意义(P>0.05)。结论 CT引导下肺部小结节经皮穿刺针吸活检和切割活检诊断具有较高的敏感度和准确率,针吸活检邻近肺野出血并发症的发生率低于切割活检。
Objective To evaluate the diagnostic accuracy and clinical value of CT-guided percutaneous biopsy for small pulmonary nodules. Methods Seventy-five cases receiving percutaneous biopsy for small(≤1 cm) pulmonary nodules from January 2015 to December 2017 were analyzed retrospectively. Among them, 65 cases were treated with Fine-Needle Aspiration, and 10 cases with Core-Needle Biopsy. The diagnostic efficacy(sensitivity and accuracy) and the incidence of common complications were compared between the two groups. Results The success rates of puncture technique were 100% in both groups. There was no difference between the sensitivity and accuracy of two groups(P>0.05). The incidence of bleeding in the adjacent lung field was 25.0% in Core-Needle Biopsy group which was significantly higher than that(4.3%) in Fine-Needle Aspiration group(P<0.05). The incidence of pneumothorax, needle bleeding and subpleural hematoma were 50.0%, 41.7%, 16.7% in Core-Needle Biopsy group, and 24.6%, 47.8%, 1.4% in Fine-Needle Aspiration group where showed no significant difference(P>0.05). Conclusions CT-guided percutaneous Fine-Needle Aspiration and Core-Needle Biopsy were sensitive and accurate in diagnosis of small pulmonary nodules. The incidence of bleeding in the adjacent lung field of Fine-Needle Aspiration is lower than that of Core-Needle Biopsy.
Objective To evaluate the diagnostic accuracy and clinical value of CT-guided percutaneous biopsy for small pulmonary nodules. Methods Seventy-five cases receiving percutaneous biopsy for small(≤1 cm) pulmonary nodules from January 2015 to December 2017 were analyzed retrospectively. Among them, 65 cases were treated with Fine-Needle Aspiration, and 10 cases with Core-Needle Biopsy. The diagnostic efficacy(sensitivity and accuracy) and the incidence of common complications were compared between the two groups. Results The success rates of puncture technique were 100% in both groups. There was no difference between the sensitivity and accuracy of two groups(P>0.05). The incidence of bleeding in the adjacent lung field was 25.0% in Core-Needle Biopsy group which was significantly higher than that(4.3%) in Fine-Needle Aspiration group(P<0.05). The incidence of pneumothorax, needle bleeding and subpleural hematoma were 50.0%, 41.7%, 16.7% in Core-Needle Biopsy group, and 24.6%, 47.8%, 1.4% in Fine-Needle Aspiration group where showed no significant difference(P>0.05). Conclusions CT-guided percutaneous Fine-Needle Aspiration and Core-Needle Biopsy were sensitive and accurate in diagnosis of small pulmonary nodules. The incidence of bleeding in the adjacent lung field of Fine-Needle Aspiration is lower than that of Core-Needle Biopsy.
引文
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[12] Kuban JD,Tam AL,Huang SY,et al.The Effect of Needle Gauge on the Risk of Pneumothorax and Chest Tube Placement After Percutaneous Computed Tomographic (CT)-Guided Lung Biopsy[J].Cardiovasc Intervent Radiol,2015,38(6):1595-1602.
[13] 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.
[2] Ohno Y,Nishio M,Koyama H,et al.Solitary pulmonary nodules:Comparison of dynamic first-pass contrast-enhanced perfusion area-detector CT,dynamic first-pass contrast-enhanced MR imaging,and FDG PET/CT[J].Radiology,2015,274(2):563-575.
[3] Yang W,Sun W,Li Q,et al.Diagnostic Accuracy of CT-Guided Transthoracic Needle Biopsy for Solitary Pulmonary Nodules[J].PLoS One,2015,10(6):e0131373.
[4] Prakashini K,Babu S,Rajgopal KV,et al.Role of Computer Aided Diagnosis (CAD) in the detection of pulmonary nodules on 64 row multi detector computed tomography[J].Lung India,2016,33(4):391-397.
[5] Lin JZ,Zhang L,Zhang CY,et al.Application of Gemstone Spectral Computed Tomography Imaging in the Characterization of Solitary Pulmonary Nodules:Preliminary Result[J].J Comput Assist Tomogr,2016,40(6):907-911.
[6] Pinsky PF,Gierada DS,Nath PH,et al.Lung Cancer Risk Associated With New Solid Nodules in the National Lung Screening Trial[J].AJR Am J Roentgenol,2017,209(5):1009-1014.
[7] MacMahon H,Naidich DP,Goo JM,et al.Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images:From the Fleischner Society 2017[J].Radiology,2017,284(1):228-243.
[8] Walter JE,Heuvelmans MA,de Jong PA,et al.Occurrence and lung cancer probability of new solid nodules at incidence screening with low-dose CT:analysis of data from the randomised,controlled NELSON trial[J].Lancet Oncol,2016,17(7):907-916.
[9] Petranovic M,Gilman MD,Muniappan A,et al.Diagnostic Yield of CT-Guided Percutaneous Transthoracic Needle Biopsy for Diagnosis of Anterior Mediastinal Masses[J].AJR Am J Roentgenol,2015,205(4):774-779.
[10] Blondiaux E,Laurent M,Audureau E,et al.Factors influencing the diagnostic yield and accuracy of image-guided percutaneous needle biopsy of pediatric tumors:single-center audit of a 26-year experience[J].Pediatr Radiol,2016,46(3):372-382.
[11] Lee SM,Park CM,Lee KH,et al.C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules:clinical experience in 1108 patients[J].Radiology,2014,271(1):291-300.
[12] Kuban JD,Tam AL,Huang SY,et al.The Effect of Needle Gauge on the Risk of Pneumothorax and Chest Tube Placement After Percutaneous Computed Tomographic (CT)-Guided Lung Biopsy[J].Cardiovasc Intervent Radiol,2015,38(6):1595-1602.
[13] 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.