CT导引下肺内病变穿刺活检诊断正确率相关因素分析

CT-guided percutaneous transthoracic aspiration biopsy of lung lesions: factors influencing the diagnostic accuracy

目的探讨影响CT导引下肺内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、临床随访的肺内病变CT导引下穿刺活检435例。应用单因素统计分析和多元逐步Logistic回归分析方法,分析病灶相关因素(病灶良恶性、大小、位置、病灶深度及有无空腔)、操作相关因素(有无激光导引、患者的体位)和患者相关因素(性别、年龄、有无肺气肿)对诊断正确率的影响。结果①435例病变最终诊断289例为恶性1、46例为良性,CT导引下穿刺活检诊断正确率为83.4%(363/435)。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72.6%(106/146)和88.9%(257/289),χ2=18.71,P=0.00002;激光组和非激光组诊断正确率分别为88.4%(130/147)和80.9%(233/288),χ2=4.00,P=0.0456;诊断正确组和非正确组病灶大小分别为(3.78±1.64)cm和(3.02±1.26)cm,F=13.79,P=0.0002。②应用多元逐步Logistic回归分析病灶的良恶性(Waldχ2=14.01,P=0.0002)、有无激光导引(Waldχ2=3.92,P=0.0477)被列入回归方程。结论病灶的良恶性和有无激光导引是影响CT导引下肺内病变穿刺活检诊断正确率的主要因素。

Objective To investigate the factors influencing the diagnostic accuracy in CT-guided pereutaneous transthoraeie aspiration biopsy of lung lesions. Methods CT-gnided pereutaneous transthoracic biopsy was performed in 435 patients with surgical pathologic confirmation or clinical follow-up. Univariant statistical analysis and multivariant stepwise Logistic regression analysis were used to study the influence of lesion-related factors （benignancy or malignancy, size, location, depth, presence of cavity）, procedure factors （laser-guidence, position of patient） and patient-related factors （sex, age, presence of emphysema）; with the accuracy of the diagnosis. Results ① 289 lesions were diagnosed as malignant ones and 146 as benign ones. The accuracy of CT-guided biopsy was 83.4% （363/435）. Univariant analysis showed that the diagnostic accuracies for malignant and benign lesions were 88.9% （257/289） and 72.6% （ 106/146）, respectively （ χ^2 = 18.71, P = 0.00002）. Laser-group was superior to non-laser group （88.4% versus 80.9%, respectively, χ^2 = 4.00, P = 0.0456）. Mean diameters of lesions in correct diagnostic group and non-correct diagnostic group were 3.78 ± 1.64 cm and 3.02 ± 1.26 cm, respectively （ F = 13.79, P = 0.0002）. ②Multivariant stepwise Logistic regression analysis showed that among the various factors influencing the final benign or malignant diagnoses （Wald χ^2 = 14.01, P = 0.0002） and using laserguidence（Wald Z2 = 3.92, P = 0.0477） were significantly associated with the diagnostic accuracy. Conclusions Final correct diagnoses （benign, malignant） are closely related to the application of laser-guidence for determining the diagnostic accuracy in CT-guided transeutaneous thoracic needle aspiration biopsy.