CT导引下经皮穿刺肺活检术三种取材方法对肺部恶性病变的诊断价值研究

Diagnostic Values of CT-Guided Lung Biopsy of Malignant Lesions Based on Three Different Sampling Methods

目的探讨CT导引穿刺活检三种取材方法对肺部恶性病变的诊断价值。方法适合CT导引下经皮穿刺肺活检术的肺部肿块或结节患者,随机分为切割活检组、针吸活检组及切割加针吸活检组,共206例,经手术病理、临床综合分析+临床随访符合恶性肿瘤者共138例,其中切割活检组47例,针吸活检组45例,切割加针吸活检组46例。比较三种取材方法对肺部恶性病变的诊断准确性。结果切割、针吸和切割加针吸三种方法特异度及阳性预测值相同,均为1.0000;灵敏度分别为0.7500、0.6875和0.9231,阴性预测值分别为0.8571、0.7500和0.9565,Youden指数分别为0.7500、0.6875和0.9231;在恶性病变病理组织学分型中,三组总的诊断正确率为69.57%(96/138),其中切割组、针吸组和切割加针吸组的诊断正确率分别为72.34%(34/47)、44.44%(20/45)和91.30%(42/46),三者比较差异有统计学意义(χ2=23.8515,P<0.001)。结论 CT导引下经皮穿刺肺活检术中,切割加针吸对肺部恶性病变的诊断准确性及病理组织学分型正确率高于单纯切割或针吸。

Objective To compare the values of three sampling methods based on the diagnostic accuracy of malignant lesions of the lungs. Methods Totally 206 patients with lung masses or nodules underwent CT - guided percutaneous lung biopsy. And 138 of them were diagnosed as having pulmonary malignant lesions by surgical pathology, clinical features and follow -up, including cutting biopsy group of 47 patients, needle aspiration group of 40 patients, and cutting plus needle aspiration biopsy 50 patients. The diagnostic accuracies of malignant lesions of the lungs by the three sampling methods were compared. Results The specificity and positive predictive value of all the three methods were 1. 0000; Sensitivities of the three different methods were 0. 7500, O. 6875and O. 9231 respectively; and the negative predictive values were O. 8571, O. 7500 and 0. 9565 respectively, Youden index were 0. 7500, 0. 6875 and 0. 9231 respectively. For malignant lesions on histopathological type, the accuracy rate of CT -guided percutaneous lung biopsy was 69. 57% （96/138）, The accurate diagnosis rates in three different methods were 72.34% （34/47）, 44.44% （20/45） and91.30% （42/46） respectively （X2 =23.8515, P〈0.001） .Conclusion In CT - guided percutaneous lung biopsy, cutting plus needle aspiration biopsy has higher rates in diagnosis accuracy of lung malignant lesions and the histological type of pathology than single cutting biopsy or needle aspiration.