CT引导下经皮肺切割活检准确率分析

Accuracy of CT-guided percutaneous automated cutting needle biopsy of lung lesions

目的评估CT引导下经皮肺自动切割术（ACNB）的诊断价值与影响其肺恶性病变活检准确率的因素。方法回顾性分析352例行ACNB检查患者的临床资料，对影响恶性病变诊断的相关因素行非条件logistic回归分析。结果平均每例穿刺时间为（16．0±2．0）min。恶性病变246例，诊断敏感性92．7％（228／246），特异度100．0％（106／106），阳性预测值100．0％（228／228），阴性预测值85．5％（106／124），假阴性18例；多因素分析显示病灶小（≤20mm）及合并肺不张是活检假阴性的危险因素。良性病变的特异性诊断率70．8％（75／106）。总准确率94．9％（334／352）。穿刺后出血率为22．7％、咯血率5．1％；气胸率17．0％，其中封闭引流2例；胸膜反应及术后疼痛超过1个月者各1例，严重并发症5例（1．4％）。结论CT引导下ACNB安全易行，诊断准确率高；病灶直径≤20mm及合并肺不张可影响恶性病变穿刺活检准确率。

Objective Purpose of this study was to evaluate the accuracy of CT-guided percutaneous automated cutting needle biopsy （ACNB） of lung lesions and to determine its influencing factors in diagnosis of malignancy. Methods Clinical data of 352 patients undergone with ACNB was retrospectively analyzed for its accuracy in diagnosis of malignancy and its potential predictive variables, with unconditional logistic regression model. Results Mean length of percutaneous puncture for ACNB was （16. 0 ±2. 0） min. Two hundred and forty-six of 352 patients were diagnosed as malignant, with sensitivity and specificity for diagnosis of malignancy of 92. 7% and 100. 0%, and positive and negative predictive values of 100. 0% and 85.5%, respectively. Overall accuracy of its diagnosis of malignancy was 94. 9%. Results of multivariate analysis showed that size of lung lesion equal to or smaller than 20 mm and those complicated with pulmonary atelectasis （with ORs of 4. 198 and 2. 210, respectively） associated with its negative positivity. Eighty （22. 7% ） cases presented pulmonary hemorrhage, 18 （5.1%） hemoptysis, 60 cases （ 17.0% ） pneumothorax and two （0. 6% ） needed a chest tube for drainage after the procedure. One case had insistent pain for more than one month and one with pleural reaction caused by pulmonary cryptococcus infection. Conclusions CT-guided ACNB was a feasible, safe and accurate method for diagnosing pulmonary lesions, pulmonary malignant lesions less than 20 mm in diameter and complicated with pulmonary maybe affect accuracy.