CT引导下分离式BARD活检枪对支气管镜阴性孤立性肺结节的诊断价值

Diagnostic value of percutaneous CT-guided separated BARD biopsy instrument in solitary pulmonary nodules of bronchoscope negative

目的探讨CT引导下分离式BARD活检枪对气管镜阴性孤立性肺结节组织活检的诊断价值。方法回顾性分析南京军区南京总医院呼吸与危重症医学科2008年1月至2014年2月期间行CT引导下经皮肺穿刺活检术并经手术病理、临床治疗或随访证实的105例孤立性肺结节患者的病例,所有患者行经皮肺穿刺术前均行纤维支气管镜检查,并且检查结果为阴性;采用分离式BARD活检枪,18G BARD穿刺针,根据螺旋CT扫描选择最佳穿刺层面及穿刺点。结果本组105例孤立性肺结节患者均取材成功,诊断结果经手术病理、临床治疗或随访观察证实,恶性病变诊断敏感性95.83%,特异性100%。良性病变敏感性96.97%,特异性95.83%,假阴性4例(3.8%)。腺癌表皮生长因子受体(EGFR)检测合格标本58例(90.63%),阳性22例(37.93%)。并发气胸11例(10.47%),咯血11例(10.47%)。结论 CT引导下分离式BARD活检枪对气管镜阴性的孤立性肺结节具有很好的临床应用价值,能为肺癌分子病理诊断分析提供足够的标本。

Objective To evaluate the diagnostic value of percutaneous computed tomography（ CT）-guided biopsy with separated BARD gun in bronchoscopy-negative solitary pulmonary nodules. Methods Total105 patients with solitary pulmonary nodules who hospitalized between January 2008 and February 2014 were reviewed. All the patients with negative result of bronchoscopy were performed by percutaneous CT-guided transthoracic needle biopsy with a separated BARD gun and 18 G BARD needle. The optimal cross-section and the fixation point were selected according to the CT scanning images. All of the nodules were confirmed either by the pathology of the surgery or the follow-up result in the clinical course. Results The specimens are successfully obtained via the biopsy in all the 105 patients. The diagnostic sensitivity and specificity of percutaneous CT-guided separated BARD biopsy in malignant lesions was 95. 83% and 100%,respectively. In the total malignant lesions,58 cases of adenocarcinoma（ 90. 63%） were up to standard of the epidermal growth factor receptor（ EGFR） mutation analysis and 22 cases（ 37. 93%） had a positive result. The diagnostic sensitivity and specificity in benign lesions was 96. 97% and 95. 83%, respectively. The incidence of pneumothorax was 11 cases（ 10. 47%） and that of hemoptysis was 11 cases（ 10. 47%）. Conclusion Percutaneous CT-guided separated BARD biopsy is an efficient and safe method with few complications in diagnosing the solitary pulmonary nodules with negative result of bronchoscopy,which can also provide enough specimens for further molecular pathological analysis in lung cancer.