CT引导下经皮肺活检诊断孤立性肺结节分析

CT-guided percutaneous transthoracic fine needle aspiration biopsy of solitary pulmonary nodules

目的提高CT引导下经皮肺活检对肺周边孤立结节诊断的敏感性和准确性。方法对14例痰细胞学及纤维支气管镜检查阴性患者均使用SiemensSomatomHiQ型CT机薄层扫描定位,拟定穿刺点,选择最佳进针角度及深度,局麻后在胸部定位尺指导下穿刺。穿刺针采用COOK公司的16、18、20G的软组织活检针或弹簧自动芯状取材活检针。CT扫描核实活检针尖已达病灶后取材,将得到的组织碎片固定、包埋,常规HE染色,必要时行组织化学及免疫化学染色,行病理学诊断。结果14例全部穿刺成功,一次穿刺活检成功率达71.4%(10/14)。病理学诊断结果:恶性病变11例,其中肺腺癌7例,鳞癌1例,小细胞癌1例,未分型癌细胞2例。良性3例,其中结核球2例,炎性假瘤1例。结论对于痰细胞学及纤维支气管镜检查不能确诊的肺周边孤立结节病灶,行CT引导下经皮肺活检具有安全准确、诊断迅速的特点,具有较高的诊断价值,值得推广。

Objective To analysize the accuracy of CT-guided pereutaneous transthoratic fine needle aspriation biosy of solitary pulmonary nodules. Methods Selected 14 patients with negative transbronchial biopsy and sputum cytology who underwent CT-guided transthoracic fine needle aspiration biopsy of solitary lung nodules, included 10 men and 4 women. Average age is 49.3. After thin-slide scanning and localization with Siemens Somatom HiQ computed tomorgraphy, the pulmonary nodules were biopsied with a 16, 18 or 20 Gauge needle guided by a ruler especially designed. Followed fixation, embedding and HE staining, biopsy materials were used for histopathologic examination. Results Eleven pulmonary nodules were proved to be malignant and 3 benign. Except for I case who was minor hemoptysis, there weren＇t complications such as pneumothorax, pulmonary hemorrhage. Conclusion CT-guided pereutaneous transthoracic fine needle aspiration biopsy is performed in peripheral solitary pulmonary nodules, which are not easily diagnosed or accessible to fibrobronchoscopes. CT-guided pereutaneous transthoracic fine needle aspiration biopsy is safe and quick for diagnosis with high accuracy for peripheral pulmonary nodules which are usually negative in sputum examination and bronchoscopy. This technic should be widely used as routine in the diagnosis of lung neoplasms.