CT导引下胸部病变穿刺活检——影响诊断正确率因素分析

Factors influencing diagnostic accuracy of percutaneous transthoracic aspiration biopsy of chest lesions under CT guidance

目的:探讨影响CT导引下胸部病变穿刺活检诊断正确率的因素。方法:回顾复习有手术病理、临床随诊的胸部病变CT导引下穿刺活检244例,观察因素包括患者相关因素(性别、年龄、有无肺气肿)、病灶相关因素(病灶良恶性、大小、位置、病灶深度及有无空腔)、操作相关因素(病人的体位)。对所有观察因素分别进行单因素和多元逐步Logistic回归分析观察其对诊断正确率的影响。结果:①244例胸部病变最终诊断165例为恶性、79例为良性,CT导引下穿刺活检诊断正确率为82.4%(201?244)。单因素统计分析显示,CT导引下穿刺活检对良、恶性病变诊断正确率分别为69.6%(55?79)和88.5%(146?165),χ2=13.1,P=0.003;诊断正确组和非正确组病灶大小分别为(3.97±1.80)cm和(3.11±1.44)cm,F=8.81,P=0.033。②应用多元逐步Logistic回归分析亦显示病灶的良恶性(Waldχ2=7.126,P=0.008)、病灶大小(Waldχ2=4.951,P=0.026)是活检诊断正确率的影响因素。其它因素对穿刺活检诊断正确率的影响无统计学意义。结论:病灶的良恶性和病灶大小是影响CT导引下胸部病变穿刺活检诊断正确率的主要因素。

Objective: To investigate factors influencing diagnostic accuracy of percutaneous transthoracic aspiration biopsy of chest lesions under CT guidance. Methods: CT-guided percutaneous transthoracic biopsy was performed in 244 patients who had surgical resection or clinical follow-up. Patient-related factors were sex, age and presence of emphysema. Lesion-related factors were histology, size, location, depth and appearance of cavity on CT. Procedure factor was position of patient (prone, supine). All factors were analyzed as single and multiple dependent factors for diagnostic accuracy. Results: ①Final diagnosis were 165 malignant lesions and 79 benign lesions. CT-guided biopsy showed 82.4% (201244) overall diagnostic accuracy. Univariate analysis showed that diagnostic accuracy in CT-guided biopsy for benign and malignant lesions were 69.6% and 88.5%, respectively (χ2=13.1, P=0.003). Mean diameters of lesions in the success and failure group were (3.97±1.80)cm and (3.11±1.44)cm, respectively(F=8.81, P=0.033). ②Using multivariate stepwise logistic regression analysis, histology(Wald χ2=7.126, P=0.008) and size(Wald χ2=4.951, P=0.026) were significantly associated with diagnostic accuracy. There were no statistically significant differences between the other factors and diagnostic accuracy. Conclusion: Histology and size of the lesions are the determining factors for diagnostic accuracy in CT-guided transcutaneous thoracic needle aspiration biopsy.