CT引导下经胸壁肺活检在肺癌精准治疗中的临床应用

Clinical application of CT guided percutaneous lung biopsy in the precise treatment of lung carcinoma

目的探讨CT引导下经胸壁肺活检在肺癌精准治疗中的临床应用。方法回顾性分析2014年12月至2016年6月在西安交通大学第二附属医院呼吸内科所做CT引导下经皮肺穿刺活检术并经手术病理、临床治疗或随访观察证实的73例患者。根据CT扫描图像选择最佳穿刺层面及穿刺点获取标本。结果 73例患者肺部病变全部取样成功,穿刺病理提示恶性肿瘤39例,良性病变34例。经手术病理、临床治疗或随访观察证实为恶性肿瘤42例,良性病变31例,诊断准确率为95.9%,灵敏度为92.9%,特异度为100%。对确诊肺腺癌的23例患者进行了基因突变检测,共检测到11例存在表皮生长因子受体(epidermal growth factor receptor,EGFR)突变,突变率为47.8%;其中以第19外显子缺失(占所有突变的36.4%)及第21外显子点突变(27.3%)发生率较高。穿刺后发生并发症14例,症状均较轻,无致死性不良反应发生。结论 CT引导下经皮肺穿刺活检术是一种创伤小、安全性高、并有较高准确性的检查方法,对肺部病变的诊断及治疗有重要的应用价值。

Objective To investigate the clinical application of CT guided percutaneous lung biopsy in the precise treatment of lung carcinoma. Method All 73 Patients underwent CT-guided percutaneous lung biopsy from December,2014 to June,2016 Department of Respiratory Medicine,Second Affiliated Hospital of Xi＇an Jiaotong University,and they was confirmed by pathology,treatment or follow-up. The best puncture and puncture points were selected according to CT scan images. Resulst All 73 cases of lung lesions were successfully sampled,and 39 cases of malignant tumor were indicated by pathology,and 34 cases were benign lesion. The diagnosis of malignancy tumors（ 42） and benign lesions（ 31） was confirmed by pathology,treatment or follow-up. The sensitivity of CT-guided percutaneous lung biopsy for malignancy was 92. 9%（ 39/42）,accuracy 95.9%（ 70/73）,specificity100%（ 39/39）. Epidermal growth factor receptor（ EGFR） gene mutations were identified in 11 of 23（ 47.8%） biopsy samples of adenocarcinoma. In-frame deletions of exon 19 occurred in 4 patients（ 36.4%） and point mutation occurred at codon858（ exon 21） in 3（ 27.3%）. After puncture,there were 14 cases with mild and non-fatal adverse reactions. Conelusion CT-guided percutaneous lung biopsy is a safe,accurate,and effective method for diagnosis of chest lesions,it is important value in the diagnosis and treatment of lung disease.