肺部小结节的CT引导经皮肺穿刺活检

Transthoracic needle biopsy of small pulmonary nodules

目的：评价 Ｃ Ｔ 引导肺小结节经皮穿刺术的准确性、并发症及诊断价值。方法：选择１９９１ 年８ 月至１９９７ 年５ 月间行经皮肺穿刺术的１５８ 例患者中，病灶直径为０．５～２．０ ｃｍ 平均（１．７±０．４）ｃｍ 的３５ 例（３５ 个结节），共做了 ３８ 次穿刺，所采组织同时作细胞学和组织学检查。经手术者病理与穿刺结果对照，其余经临床随访而明确诊断。结果：３５ 例中癌 ２４ 例（原发支气管肺癌１９ 例，转移癌５ 例），穿刺阳性者共２１ 例，３ 例假阴性，无假阳性。穿刺确诊１１ 例良性病变，并经手术和随访证实。阳性和阴性预测值分别为１００％ 和７９％ 。共有５ 例（１３％ ）发生气胸，无１ 例经闭式引流或抽气处理。结论：肺小结节经皮肺穿刺术与较大结节或肿块穿刺比较同样具很高的敏感性，且临床价值更大，值得推广。

Objective:To evaluate the diagnostic accuracy,complications, and usefulness of CT guided transthoracic needle biopsy of small pulmonary nodules. Methods: Between August 1991 and May 1997,158 patients underwent transthoracic needle biopsy of pulmonary lesions.Thirty five lesions were presented small nodules,defined as lesions of 2.0 cm or less maximum diameter.A total of 38 biopsies were performed in the 35 lesions. Results: There were 11 benign lesions and 24 cancers (19 primary, 5 metastatic).Transthoracic needle biopsy findings were positive for cancers in 21 cases.In all 3 false negative lesions, only one biopsy was performed.There were 11 true negative results and no false positive results. Positive and negative predictive value were 100% and 79%,respectively. Pneumothorax occurred in 5(13%)of 38 biopsies,but no chest tube placement was necessary. Conclusion:CT guided transpulmonary biopsy of small pulmonary nodules can produce diagnostic yields comparable with that of larger lesions, and has a definitive diagnostic value of clinical utility.