螺旋CT透视下经皮穿刺活检在肺部小结节病变中的应用

CTF-guided transthoracic needle biopsy of small pulmonary nodules

目的 评价螺旋CT透视引导下肺小结节病变经皮穿刺术的准确性及临床应用价值。方法 对 2 3例病灶直径为 0 5～ 2 0cm平均 (1 7± 0 4)cm的小结节 ,共做了 2 9次穿刺 ,所采组织同时作细胞学和组织学检查。全部病例经手术病理与穿刺结果对照 ,其余经临床随访而明确诊断。结果 2 3例中恶性肿瘤 10例 (原发支气管肺癌 9例 ,转移癌 1例 ) ,穿刺阳性者共 8例 ,2例假阴性 ,无假阳性。穿刺确诊 13例良性病变 ,并经手术病理和随访证实。良恶性结节总的准确度为 91% (2 1/ 2 3 )。其中 8例(3 4 78% )发生气胸 ,1例经抽气处理。结论 螺旋CT透视引导下肺小结节经皮肺穿刺术具有很高的敏感性和特异性 ,且临床价值大 。

Objective To evaluate the diagnostic accuracy and clinic usefulness of spiral CT fluoroscopy (CTF) guided transthoracic needle biopsy of small pulmonary nodules. Methods A total of 29 biopsies were performed in the 23 lesions (diameter≤2 0 cm). All of the specimens were examined cytologically and histologically, and compared with those surgically removed. Results There were 13 benign lesions and 10 malignant tumors (9 primary, 1 metastasized). Transthoracic needle biopsy findings were positive for cancers in 10 cases. Positive findings were in 8 cases with biopsy, 2 were false negative lesions, and no false positive lesion was seen.There were 13 true negative results and no false positive results. Total accuracy was 91%(21/23). Pneumothorax occurred in 8 (34 78%) of 29 biopsies, but no chest tube placement was necessary. Conclusion CTF guided transpulmonary biopsy of small pulmonary nodules can produce diagnostic yields comparable with that of larger lesions, and has a definitive diagnostic value in clinic.