642例CT引导下经皮肺穿刺活检病理诊断分析

Percutaneous transthoracic lung biopsy:a pathological analysis of 642 cases

目的探讨经皮肺穿刺活检技术对肺部病变病理诊断的价值。方法收集642例住院患者肺部病变在CT引导下经皮肺穿刺活检组织的临床病理检查资料,进行回顾性分析并结合文献进行总结。结果在642例中,经病理组织学检查明确诊断者533例(83.0%),描述性病理诊断98例(15.3%),无临床意义的病理诊断11例(1.7%)。诊断原发于肺的肿瘤及瘤样病变共280例(52.5%),其中恶性上皮性肿瘤239例(85.4%),诊断肺腺癌者129例(54.0%);肺间叶源性肿瘤11例(3.9%),炎性肌纤维母细胞瘤3例(27.3%);淋巴瘤14例(5.0%)。胸腺瘤4例(1.4%);转移性肿瘤18例(3.4%)。非肿瘤性病变者共235例(44.1%),其中肉芽肿性炎性病变61例(26.0%)(含肺结核29例),真菌感染7例(肺隐球菌病2例),W egner肉芽肿2例;非特异性炎性病变者共174例(74.0%)。结论经皮肺穿刺活检技术是诊断肺部病变尤其是确定外周性肿瘤和肺弥漫性病变性质的有效手段,免疫组织化学技术的运用对于明确肺部病变的性质,提高病理诊断准确率,减少不必要的重复检查项目,具有重要作用。

Purpose To investigate the value of percutaneous transthoracic biopsy in the pathological diagnosis for pulmonary lesions.Methods The clinicopathologic data of 642 patients with CT-guided percutaneous transthoracic biopsy of pulmonary lesions were retrospectively analyzed and summarized with review of literatures.Results Among 642 cases,the accurate diagnosis accounted for 533 cases（83.0%）,descriptive pathological diagnosis was 98 cases（15.3%）,and the diagnosis without any clinical significance was 11 cases（1.7%）,respectively.280 cases（52.5%） were diagnosed as primary lung tumors and tumor-like lesions,of which 239 cases were malignant epithelial tumors（85.4%）,including adenocarcinoma in 129 cases（54.0%）;11 cases（3.9%） were diagnosed as mesenchymal tumours,of which inflammatory myofibroblastic tumours were 3 cases（27.3%）;14 cases（5.0%） were diagnosed as lymphoma,4 casess（1.4%） were diagnosed as thymoma;metastatic tumors to the lung were 18 cases（3.4%）;235 cases（44.1%） were diagnosed as non-neoplastic lesions,of which granulomatous inflammatory lesions were 61 cases（26.0%） including 29 cases of tuberculosis,7 cases of fungous infection（pulmonary cryptococcosis,2 cases）,and 2 cases of granulomatosis,and non-specific inflammatory lesions were 174 cases（74.0%）.Conclusions Percutaneous transthoracic biopsy is an effective approach to diagnose pulmonary lesions,especially determining the nature of peripheral tumors and diffuse pulmonary diseases.The use of immunohistochemistry plays an important role in determining the nature of lung lesions,improving the accuracy of pathological diagnosis,and reducing unnecessary repeated examinations.