孤立肺微结节86例CT引导下经皮穿刺取材活检术

The clinical application of CT-guided percutaneous puncturing biopsy for the diagnosis of isolated pulmonary micro-nodule

目的探讨CT引导经皮穿刺活检术对肺部孤立性微结节的临床应用价值。方法采用CT引导经皮穿刺术对86例肺部直径≤1 cm孤立性微结节取材活检,并与手术或临床随访诊断结果进行对比,分析其灵敏度、特异度、准确度及并发症情况。结果本组中该方法对恶性结节32例的诊断灵敏度达87.5%(28/32),阳性预测值为100%;对良性结节56例的诊断特异度为100%,阴性预测值为85.7%(24/28);总诊断符合率为92.9%(52/56)。气胸发生率7.1%(4/56),咳血发生率为8.9%(5/56),均未行特殊处理而自愈。多因素logistic回归分析显示,穿刺次数是气胸发生的危险因素(χ2=4.088,P=0.043),也是咳血的危险因素(χ2=5.659,P=0.017),而结节大小和上述并发症无明显相关性。结论 CT引导经皮穿刺活检术对肺部直径≤1 cm孤立性微结节的诊断准确性较高且并发症少。

Objective To discuss the clinical application of CT-guided percutaneous puncturing biopsy for the diagnosis of isolated pulmonary micro-nodule （≤ 1 cm）.Methods CT-guided percutaneous puncturing biopsy was performed in 86 patients having isolated pulmonary micro-nodule with ≤ 1 cm diameter.The results were compared with surgical,pathological and clinical follow-up findings.The diagnostic sensitivity,specificity and accuracy of this technique were evaluated.The complications and its clinical applications were discussed.Results In this study group the diagnostic sensitivity for malignant nodules was 87.5% （28/32） and the positive predictive value was 100%,while the diagnostic sensitivity for benign nodules was 100% and the negative predictive value was 85.7% （24/28）.The total diagnostic coincidence rate was 92.9% （52/56）.Pneumothorax occurred in 7.1% of patients （4/56） and hemoptysis in 8.9% of patients （5/56）,and both pneumothorax and hemoptysis were self-limited without giving any special management.The multi-factor logistic regression analysis indicated that the number of puncturing times was the risk factor for both pneumothorax （x2 =4.088,P =0.003） and hemoptysis （x2 =5.659,P =0.017）,while the size of the nodule was not related to the above mentioned complications.Conclusion For the diagnosis of isolated pulmonary micro-nodule （≤ 1 cm）,CT-guided percutaneous puncturing biopsy carries higher diagnostic accuracy with fewer complications.