胸腔包块经CT导引细针穿刺活检的病理诊断

Pathodiagnosis of thoracic masses by CT-guided percutaneous transthoracic fine needle aspiration biopsy

目的提高胸腔包块细针穿刺活检病理诊断的正确率，减少误诊。方法收集胸腔包块ＣＴ导引下经皮细针穿刺活检（ＰＴＦＮＡＢ）２４８例，以组织学诊断为主结合细胞学观察。以细胞学诊断与组织学诊断比较、组织学诊断以术后病理诊断为判定标准，分别统计两者诊断的准确性。结果良性病变４５例，恶性病变１９４例。细胞学灵敏度为６９．１％（１３４／１９４）、特异度为７０．１％（９４／１３４）；组织学诊断２３１例其灵敏度为９６．６％（２３１／２３９）；３４例手术后组织病理诊断，其组织学灵敏度为９７．１％（３３／３４）、准确度为９１．２％（３１／３４）。结论ＣＴ导引胸腔包块细针穿刺活检具有创伤小、定位准确的特点。在诊断上以组织学为主，因其诊断的灵敏度高，可以确定肿瘤的性质及类型，并且可进一步提供病变的生物学信息。

Objective To improve the accuracy of pathodiagnosis by CT-guided percutaneous transthoracic fine needle aspiration biopsy (PTFNAB) of thoracic masses. the pertinent influence factors were studied. Method Two hundred forty-eight cases of thoracic masses were studied After CT-guided PTFNAB. the sampls underwent histodiagnosis assisted with cytodiagnosis. The cytodiagnostic accuracy of biopsy was evaluated by histodiagnosis which in turn is tested by postoperative pathological approach Result Forty-five cases were benign, 194 malign. The sensitivity rate was 69.1%(134/194), specitivity rate 70. 1%(94/134) cytopathologically. Compared with 34 cases studied postoperatively and pathologically. the sensitivity rate was 97, 1 %(33/34). with an accuracy rate of 91.2%(31/34) by histodiagnosis. Conclusion CT-guided PTFNAB of thoracic masses provides one way for safe and accurate localization, and histodiagnosis of the biopsy samples offers the diagnosis with better accuracy and more biologic information of the tumor. PTFNAB should he widely used as a routine examination in the diagnosis of thoracic masses.