CT引导下经皮穿刺活检在纵隔占位性病变中的诊断价值

CT-guided percutaneous biopsy for the diagnosis of mediastinalmass lesion

目的国内对于CT引导下经皮穿刺活检在纵隔占位性病变中应用的研究较少。文中主要探讨CT引导下穿刺活检术在诊断纵隔占位性病变的临床应用价值及其安全性。方法回顾性分析2009年1月至2017年6月就诊于南京军区南京总医院呼吸与危重症医学科行CT引导下经皮穿刺活检术的81例纵隔占位性病变患者资料。活检标本行细胞学及组织学检查,对形态学恶性标本进一步行免疫组化染色,以最终诊断为金标准,统计CT引导下经皮穿刺活检术在纵隔占位性病变诊断中的准确性、特异性、敏感性、阳性预测值及阴性预测值和并发症情况。结果 81例患者均顺利完成CT引导下穿刺活检,77例获得明确诊断,确诊率为95.1%。恶性病变68例(84.0%),包括非小细胞肺癌44例,小细胞肺癌6例,淋巴瘤11例,恶性胸腺瘤4例,基底细胞癌1例,后纵隔恶性肿瘤1例,上皮样血管内皮瘤1例;良性病变10例(12.3%),纤维组织增生/大片坏死物2(2.5%)。CT引导下经皮穿刺活检的敏感度、特异度、准确性、阳性预测值及阴性预测值分别为94.4%、100%、95.1%、100%、69.2%。所有患者均能耐受操作,术中及术后除观察到少量气胸、咯血、穿刺点少量出血外,未出现纵隔气肿、纵隔血肿、大血管损伤破裂出血、纵隔炎等罕见并发症。结论对于纵隔占位性病变的患者,CT引导下经皮穿刺活检是一种高效、安全的检查手段,具有较高的敏感度、特异度和确诊率,可为后续治疗提供帮助。

Objective Few reports are seen on the application of CT-guided percutaneous biopsy （CT-PB） in the diagnosis of mediastinal mass lesion （MML）. This study aimed to investigate the clinical application value and safety of CT-PB in detection of MML.Methods This retrospective study included 81 patients hospitalized in our Department of Respiratory and Critical Care Medicine, who underwent CT-PB for MML.We performed cytological and histological examinations of the biopsy specimens and immunohistochemical staining on the morphologically malignant samples.With the final diagnosis as the gold standard,we analyzedthe accuracy, specificity, sensitivity, positive and negative predictive values, and complications of CT-PB in the diagnosis of MML.Results CT-PBwas successfully performed in all the 81 cases,definite diagnosis achieved in 77 （95.1%）,malignancy detected in 68 （84%）, benign lesions in 10 （12.3%）,and fibrous hyperplasia /massive necrosis in 2 （2.5%）.The sensitivity, specificity, and positive and negative predictive values were 94.4%, 100%,100% and 69.2%, respectively.All the patients were well tolerated without seriouscomplications.Conclusion For patients with mediastinalmass lesion, CT-guided percutaneous biopsy is anefficient and safe diagnostic tool with high sensitivity, specificity, and diagnostic accuracy, which may contribute to the subsequent treatment.