^(18)F-FDG PET/CT高摄取对于CT引导下经皮肺穿刺活检靶点选择的临床价值

Clinical value of ^(18)F-FDG PET/CT accumulations for pinpointing the best location in CT guided percutaneous lung puncture biopsy

目的:探讨结合18F-FDG PET/CT高摄取选择活检靶点在CT引导下肺穿刺活检术中的临床价值。方法 :回顾性分析2013—2014年间在我院行CT引导下经皮肺穿刺切割活检术的22例病例,术前行PET/CT检查,靶点的选择参考18F-FDG PET/CT显像浓聚情况。采用栅标记法体表定位,使用多层螺旋CT引导行经皮肺穿刺切割活检。结合病理和随访结果分析PET/CT确定穿刺靶点协同常规CT引导经皮肺穿刺活检的临床价值。结果:40.9%(9/22)病灶高摄取区位于边缘或偏心处,穿刺靶点进行相应调整。22例患者穿刺活检均一次完成,并发症表现为少量气胸3例,肺内少量出血6例,无咯血。穿刺活检病理回报腺癌13例、鳞癌5例、小细胞癌1例、炎性肉芽肿2例、真菌感染1例。与术后及长期随访结果相比较,1例肺癌误诊为炎性假瘤,一针活检准确率95.65%,阳性预测值100%、阴性预测值66.7%、敏感性95%、特异性100%。结论:参考18F-FDG PET/CT图像选择经皮肺穿刺活检靶点,对提高活检的准确度有重要临床价值。

Objective： To analyze the collaborative application value of 18F-FDG PET/CT in CT guided lung percutaneous needle biopsy. Methods： A retrospective analysis of 22 patients who underwent both 18F-FDG PET/CT checking and CT-guided chest percutaneous puncture biopsy from 2013 to 2014 was done. The lung puncture target was mainly selected according to18F-FDG PET/CT imaging. All of the cases received multi-slice spiral CT guided percutaneous lung puncture biopsy, surface located by grid markers. Combined with pathological and follow-up results, the collaborative diagnostic value of18F-FDG PET/CT accumulations for pinpointing the best location in CT guided percutaneous lung puncture biopsy was studied. Results：40.9%（9/22） of the high uptake area of lesions were located on the edge or eccentric place, and puncture target spot was adjusted correspondingly. All of the 22 cases of biopsy were performed one time successfuly. The complications were slight pneumothorax in 3 cases and little pulmonary hemorrhage in 6 cases, without hemoptysis. There were 13 cases of adenocarcinoma, 5 cases of squamous cell carcinoma, 1 case of small cell carcinoma, 2 cases of inflammatory granuloma, and 1 case of fungal infection. Compared with the postoperative and long-term follow-up, only one case of lung cancer was misdiagnosed as inflammatory pseudotumor. The accuracy rate of single percutaneous lung puncture biopsy was 95.65%. The positive predictive value and negative predictive value, sensitivity, specificity were 100%, 66.7%, 95%, 100%, respectively. Conclusion：18F-FDG PET/CT image can help to select the target of percutaneous lung biopsy, and to improve the accuracy of biopsy, which has important clinical value.