术中肺内肿物穿刺活检诊断肺内单发结节的效果

Diagnostic accuracy research of needle puncture biopsy during operation for pulmonary single nodules

目的明确术中对肺内肿物进行穿刺冰冻病理检查的优缺点、注意事项，及其是否可以代替肿物切除活检。方法选取2010年1-10月间50例肺内肿物患者，男性28例，女性22例；年龄41-77岁，平均年龄59岁。影像学检查为肺内单发结节。在开胸手术或胸腔镜手术下，细针穿刺肿瘤进行术中冰冻病理检查。记录穿刺过程中的并发症，所有的切除标本术后行石蜡病理检查，以确定肿瘤的病理性质。分析术中冰冻病理检查与术后石蜡病理检查之间的关联度。结果本组患者的肿瘤大小为1．0cm×0．6cm-5．6cm×9．0cm。以术后石蜡病理诊断为金标准，最终确诊良性肿瘤7例，恶性肿瘤43例。术中穿刺活检诊断的灵敏度为90．7％，特异度为100％，阳性预测值为100％；阴性预测值为63．6％。11例术中穿刺诊断为良性的患者中，有4例术后石蜡病理诊断为恶性肿瘤，假阴性率为9．3％。术中穿刺活检的主要并发症为穿刺过程中损伤肿瘤周围血管，造成穿刺点出血，发生率为4．0％（2／50）。结论术中穿刺肿瘤进行冰冻病理检查的特异度较高，但有一定的假阴性率；术中穿刺活检可以在一定程度上替代术中肿物的切除活检。

Objective To investigate the diagnostic accuracy of needle puncture biopsy and pathological examination of frozen during operation for pulmonary nodules, and whether this diagnostic method can replace tumor resection examination. Methods Totally 50 patients （28 males and 22 females, average age was 59 years） who had the single nodule after imaging examination without any pathological diagnostic from January to October 2010 were selected in this research work. During open operation or video assisted thoracic surgery, needle （ 14 G model） was used to puncture biopsy for pathological examination of frozen. All the adverse events during puncture biopsy would be recorded. The resection specimens would be accepted paraffin pathological examination. The relationship between puncture frozen pathological and paraffin pathological examination was analyzed. Results All tumor sizes were ranged from 1.0 cm×0. 6 cm to 5.6 cm× 9. 0 cm. The paraffin pathological examination after operation as the golden standard, there were 7 cases of benign tumor and 43 cases of malignant tumor. The diagnostic sensitibility of puncture biopsy was 90. 7%, the specificity was 100%, the positive predictive value was 100% and the negative predictive value was 63.6%. There were 11 cases of benign tumor diagnosed by needle puncture biopsy, among which 4 cases were proved as malignant tumor by paraffin pathology, and the false negative rate was 9. 3%. The main risk of puncture biopsy was bleeding after puncture immediately, and the rate was 4. 0% （2/50）. Conclusions The puncture biopsy during operation had a high specificity for malignant lung tumor, and there was a certain false negative rate for benign tumor. Puncture biopsy and pathological examination offrozen tissue can replace tumor section biopsy in a way.