CT引导下经皮穿刺同轴细针活检术诊断纵隔占位性病变40例

CT-guided percutaneous coaxial fine needle biopsy for the diagnosis of mediastinal space-occupying lesions: initial experience in 40 cases

目的评价CT引导下经皮穿刺同轴细针活检术对纵隔占位性病变诊断的技术成功率、诊断正确率和安全性。方法在CT引导下采用18 G带芯穿刺针穿刺40例纵隔占位性病变,然后经18 G穿刺针的外套针同轴引入20 G切割活检细针对纵隔病变行经皮同轴穿刺活检。结果 40例患者的纵隔占位性病变接受41次活检,其中1例患者先后接受2次穿刺活检。CT证实41次经皮穿刺的穿刺针皆位于纵隔占位病灶内,37次活检病理结果与临床最终诊断相一致。本组资料穿刺技术成功率100%,穿刺活检诊断准确率90.2%。2例出现少量气胸,肺组织压缩程度小于20%,随访过程中自行吸收,无其他穿刺相关并发症发生。结论 CT引导下经皮同轴穿刺活检术诊断纵隔占位性病变是安全、准确、微创的介入诊断技术。

Objective To assess the technical CT- guided percutaneous coaxial fine needle biopsy mediastinum. Methods During the period from Nov success rate, diagnostic accuracy and clinical safety of for the diagnosis of space- occupying lesions of the 2006 to May 2013, CT-guided percutaneous coaxial fine needle biopsy was carried out in 40 patients with mediastinal space-occupying lesions. Using an 18 G trocar needle the mediastinum lesion was punctured, then through its cannula a 20 G fine biopsy needle was coaxially inserted into the lesion to make the biopsy. The pathological findings and the clinical results were analyzed. Results A total of 41 percutaneous coaxial needle biopsies were performed in 40 patients with space- occupying lesions of the mediastinum. One patient received twice puncture procedure. CT scanning proved that the biopsy needle was fight within the mediastinal lesion in all the 41 biopsy procedures. The pathologic findings were consistent with the final clinical diagnosis in 37 needle biopsies. Technical success rate in this series was 100%. The diagnostic accuracy was 90.2%. No severe puncture-related complications occurred except for two patients who developed mild pneumothorax after the biopsy, with the lung being compressed less than 20%, which was spontaneously absorbed during the follow-up time. Conclusion For the diagnosis of space- occupying lesions of the mediastinum CT- guided percutaneous coaxial fine needle biopsy is a safe, proper and minimally- invasive interventional technique. （J Intervent Radiol, 2014, 23： 1056-1058）