CT导引下胸部病变穿刺活检的临床分析

Clinical application with CT-guided percutaneous transthoracic aspiration biopsy

目的:评价CT导引下穿刺活检在胸部病变诊断中的价值。方法:有手术病理或临床随诊的胸部病变CT穿刺活检223例,其中125例133次活检为传统CT导引下活检,其余98例105次CT穿刺活检应用激光导引装置。结果:223例胸部病变中212例有临床诊断结果,CT穿刺活检诊断正确率为82.1%(174/212),对恶性病变的敏感率86.2%(131/152),特异性100%、对良性病变明确诊断率为71.7%(43/60)。并发症包括13.0%(31/238)发生气胸,1.3%(3/238)需要放胸腔引流管,5.0%(1/238)发生肺实质少量出血,0.8%(2/238)出现少量咳血。激光导引下CT穿刺活检诊断正确率为88.4%(84/95),明显高于传统CT导引下活检76.9%(90/117)的诊断正确率,两者在气胸发生率、每次活检平均胸膜穿刺次数方面无统计学差异。结论:CT导引下胸部病变穿刺活检是一种安全、准确、有效的诊断及鉴别诊断方法。激光导引装置在胸部CT穿刺活检中有较高的应用价值,尤其对于小病灶和中心性病变。与传统CT导引下活检相比激光导引下CT活检可提高诊断证确率、缩短活检时间。

Objective： To evaluate the clinical application of CT-gnided percutaneous transthoracic aspiration biopsy. Methods： CT-guided pcrcutaneous transthoracic biopsy 223 cases. All 223 cases had surgical pathology or clinical follow-up, of which 98 cases （ 105 biopsies） were performed with laser-guidance device, 125 cases （133 biopsies） with conventional CT guidence. Results：212 of 223 lesions have final diagnoses. CT-guided biopsy showed 82.1% （174/212） overall accuracy, 86.2% （131/152） sensitivity, 100% specificity and 71.7 % （43/60） specific diagnosis of benign lesions. Complications included pneumothorax in 31 （ 13 % ） of 238 biopsies; chest tube insertion in 3（1.3%） of 238 biopsies： minor pulmonary hemon＇hage in 12（5%） of 238 biopsies; and hemoptysis in 2 （0.8%） of 238 biopsies. Laser-guided biopsy was superior to conventional CT-guidad biopsy for the overall diagnostic accuracy （88.4% for laserguidence versus 76.9% for conventional CT-guidance. There were no statistical difference in pneumothorax rate, biopsy time between laser-guided CT biopsy and conventional CT-guided biopsy. Conclusion： CT-guided percutaneous transthoracic aspiration biopsy wasa quick, safe and effitive method for diagnosis and differential diagnosis. Laser-guidance device was quite helpful for CT biopsy, especially for small nodules and central lesions. Compared with conventional CT-guided biopsy, laser-guided CT biopsy significantly increased the overall diagnesitic accuracy and decreased biopsy time.