522例肺部病变CT引导经皮切割针活检总结

Clinical evaluation of percutaneous transthoracic needle core-biopsy under CT guidance (with 522 cases reports)

目的总结CT引导经皮切割针穿刺活检术对肺部病变诊断的准确性、灵敏度、特异度和并发症。方法收集1992年以来,取材成功并有完整资料的522例CT引导经皮肺部切割针穿刺活检病例作回顾性分析。其中肺部结节或肿块性病变467例,其他病变55例。统计该法诊断灵敏度、特异度和并发症,并分析其影响因素。结果476例获得组织标本并有病理学结果,取材成功率为91.2%(476/522)。301例病理确诊为恶性肿瘤,包括腺癌107例,鳞状细胞癌84例,不能分型恶性肿瘤59例,小细胞未分化癌16例,肺转移瘤22例,低度恶性肿瘤3例,肺肉瘤3例,细支气管肺泡细胞癌2例,5例病理报告为"癌变可疑",后证实为支气管肺癌。17例穿刺病理为"癌变可疑",后证实为良性病变。穿刺未发现癌细胞者204例,其中明确诊断为良性病变102例(结核41例,非特异性肺炎21例,慢性炎症18例,支气管扩张7例,炎性假瘤6例,曲霉感染5例,隐球菌性肺炎3例,良性纤维组织细胞瘤1例)。非特异性病理结果的良性病变73例。另29例穿刺未发现肿瘤组织,而后证实为恶性肿瘤,系假阴性。阳性预测值为94.7%〔301/(301+17)〕,灵敏度为91.2%〔301/(301+29)〕,特异度为91.1%〔175/(175+17)〕,假阴性率为14.2%(29/204)。54例发生气胸,占10.3%(54/522),仅1.5%的病例(8/522)行抽气或置管闭式引流处理。肺出血42例,咯血36例,均未经特殊处理而自愈。结论CT引导经皮切割针肺部病灶活检具有较高的诊断灵敏度和特异度,有助于提高良性病变的诊断准确性,同时并不显著增加气胸和出血等并发症的发生率。

Objective To evaluate the diagnostic accuracy, sensitivity, specificity and complications of transthoracic needle core-biopsy of pulmonary lesions under CT guidance , and to compare with those biopsies under fine-needle aspiration. Methods 522 patients who underwent transthoracic needle biopsy under CT guidance were enrolled including 467 pulmonary nodules or masses, and 55 with diffuse pulmonary diseases, but no pleural or chest wall lesions were enrolled. Both histopathologic and cytopathologic analyses were involved together with positive predictive value, sensitivity, specificity, accuracy, falsenegative rate and complication （pneumothorax） were analyzed as well. Results 476 cases with obtained enough specimens got accurate pathological diagnosis of 91.2% total acuracy （476/522）. 301 cases were proved to be malignant tumors, including adenocarcinoma （n = 107）,squamous cell carcinoma （n = 84）, malignancy with no specified type （n = 59）, small cell lung cancer （n=16）,metastatic lesiions （n = 22）, lower-degree malignant tumors （n = 3）, pulmonary sarcoma（n = 3）, bronchioloalveolar carcinoma（n = 2）, and suspected malignancy （n = 5）. 17 cases were suspected of cacinomatous charge, whereas they were confirmed to be benign etities eventually. 129 cases hadn＇t been found carcinomatous cells, which could be classified as specific-negative results in 102 cases, non-specific results 73, and the remained 29 cases were assigned to be false-negative and later proved to be cancer via operation and followed-up. Positivepredictive value was 94.7%（301/（301±17））; sensitivity and specificity were 91.2%（301/（301±29））and 91.1%（175/（175±17））, respectively. False-negative rate was 14.2% （29/204）. Pneumothorax oecured in 54 eases with the rate of I0.3%（54/522）, but chest tube placement and drainage were established in only eight eases（1.5%）. Pulmonary hemorrhage and hemoptysis oeurred in 46 and 32 eases. One patient had hemoptysis over 50 ml,but no additional treatment was conducted. Conclusion CT-guided transthoracie core-biopsy is a safe and valuable diagnostic method with lower false negative rate, therefore, it may further improve the accuracy rate of percutaneous needle biopsy.