经皮肺活检术对不同部位肺部肿块的诊断价值

Diagnostic Values of Percutaneous Lung Biopsy in Different Malignant Lesions

目的:探讨在CT引导下经皮穿刺肺活检术对肺部不同部位病灶性质的诊断价值。方法:206例肺部肿块或结节的患者在CT引导下行经皮穿刺肺活检术,根据取材方法将患者随机分为切割活检组、针吸活检组及切割加针吸活检组,分别采用这3种取材方法对不同病变部位肺组织进行取材,获取组织送病理检查或细胞学涂片检查,比较3种取材方法对肺部病灶与胸膜距离≤2 cm组和>2 cm组病变性质和部位的诊断正确率、特异度、灵敏度和并发症。结果:病灶距胸膜距离≤2 cm组的诊断正确率(81.48%)高于距胸膜距离>2 cm组(67.35%)(P=0.019 7),病灶距胸膜距离≤2 cm组灵敏度(0.911 8)高于>2 cm组(P=0.800 0),两组特异度均为1.000 0;病灶距胸膜距离≤2 cm组中,3组诊断正确率比较,差异无统计学意义(P=0.093 4)。病灶距胸膜距离>2 cm组中,切割加针吸组的诊断正确率最高(P=0.028 2);两组中,均以切割加针刺组灵敏度均最高(分别为1.000 0和0.916 7);病灶距胸膜≤2 cm组发生气胸和出血的比例均低于病灶距胸膜>2 cm组(气胸P=0.000 2,出血P=0.037 7)。结论:CT定位下经皮穿刺肺活检术中,病灶距胸膜≤2 cm组诊断正确率高,并发症低。

Objective： To explore diagnostic value of three CT-Guided percutaneous lung biopsy methods for different lung lesions site. Methods： Totally 206 patients with lung biopsy of lung masses or nodules who were suitable for CT-Guided percutaneous puncture were divided into three groups ac- cording to different biopsy method （cutting biopsy group, needle aspiration biopsy group and cutting combined with needle aspiration biopsy group）. Then the tissue taken by the three biopsy in different lung lesions site underwent pathological examination or cytological smear examination, and the rate of correct diagnosis, specificity, sensitivity and complications were compared between the group whose distance from lesion site to pleura was less than or equal to 2 cm and the group whose distance from le- sion site to pleura was more than or equal to 2 cm by the three biopsy methods. Results： The diagnos- tic accuracy rate of group whose distance from lesion site to pleura was less than or equal to 2 cm （81.48%） was higher than that of group whose distance from lesion site to pleura was more than 2 cm （67.35% ,P = 0.019 7）. The diagnostic sensitivity of group whose distance from lesion site to pleura was less than or equal to 2 cm （0.911 8） was higher than that of group whose distance from lesion site to pleura was more than 2 cm （0. 800 0）. Both diagnostic specificity in two groups was 1. 000 0. In the group whose distance from lesion site to pleura was less than or equal to 2 cm, the diagnostic accu- racy rates of the three methods were not statistically significant （P = 0. 093 4）. However, in the group whose distance from lesion site to pleura was more than 2 cm, the diagnostic accuracy rate of cutting combined needle aspiration biopsy group was highest in the other group （ Y = U. U2U 2）. In two groups, the diagnostic sensitivity in cutting combined needle aspiration biopsy group was all the highest （ 1. 000 0 and 0.916 7 ）. The incidence of pneumothorax and bleeding in group whose distance from lesion site to pleura was less than or equal to 2 cm was lower than that in group whose distance from le- sion site to pleura was more than 2 cm （ P = 0. 000 2 ; P = 0. 037 7, respectively）. Conclusion ： In CT-guided percutaneous lung biopsy, the diagnostic accuracy rate of group whose distance from lesion site to pleura is less than or equal to 2 cm is higher and incidence of complications is lower.