多层螺旋CT与立体定向穿刺系统导引下肺内小结节穿刺活检的临床应用

Biopsy guided by pinpoint stereoscopic system and multislice helical CT in small intrapulmonary nodule (less than 2cm in diameter)

目的探讨多层螺旋CT(MSCT)与立体定向穿刺系统(Pinpoint)导引下穿刺活检术在肺内小结节(<2cm)诊断的临床应用价值。方法32例肺内小结节,均经MSCT与Pinpoint导引穿刺行组织学检查,分析穿刺病理取材正确率及并发症发生率。结果32例均经手术病理及临床随访而明确诊断。其中恶性22例,良性病变10例,穿刺确诊30例;2例穿刺未取得病理结论,经手术证实分别为腺癌、错构瘤。恶性预测值及敏感性分别为100%,95.7%,穿刺总准确性93.8%。气胸2例(6.2%),未经闭式引流或抽气处理;肺出血4例(12.5%),其中1例有一过性咯血,均未经特殊处理。结论MSCT与Pinpoint导引下肺内小结节穿刺活检可以获得较好的组织学标本,是一种安全、准确的诊断和鉴别方法。

Objective To evaluate the clinical value of pinpoint stereoscopic system in muhislice helical CT-guided biopsy of small intrapulmonary nodule. Methods A total of 32 cases of small pulmonary nodules less than 2cm in diameter were taken biopsies guided by muhislice helical CT and pinpoint stereoscopic system. The accuracy of biopsy and the rate of complication were analyzed. Results All cases had a definite diagnosis by pathology and clinical follow-up. There were 10 benign lesions and 22 malignant tumors. Positive findings were in 30 cases with hiopsy. 2 cases had no pathologic results, one of them was adenocarcinoma and the other was hamartoma verified by operation. The overall diagnostic accuracy was 93.8 %. Complications were 2 cases of pneumothorax （6.2 %） and 4 cases of pneumorrhagia （12.5%） with no chest tube placement and other peculiar treatment. Conclusion Directed by pinpoint stereoscopic system, MSCT-guided puncture biopsy of small pulmonary nodules is a good method to get histological result. It was a safe and effective method for diagnosis and differential diagnosis.