锥形束CT联合iGuide引导系统在经皮经胸肺穿刺活检术中的应用

Application of cone-beam CT combined with iGuide system in percutaneous transthoracic needle biopsy of pulmonary lesions

目的探讨锥形束CT(CBCT)联合iGuide引导系统在经皮经胸肺穿刺活检术(PTNB)中的应用价值。方法纳入30例因肺部单发病灶接受PTNB的患者。CBCT扫描后,通过iGuide引导系统和三维类CT多平面重组图像规划穿刺路径。采用18G同轴切割针行穿刺活检。记录手术相关资料、穿刺并发症及辐射剂量。结果 30例患者中,穿刺活检病理结果显示恶性病变24例,良性病变6例;28例符合最终病理诊断,1例为取材不够,但重新取材后的病理结果符合最终病理诊断,1例为假阴性结果。PTNB诊断肺部病变的准确率、敏感度、特异度、阳性预测值及阴性预测值分别为96.67%(29/30)、96.00%(24/25)、100%(5/5)、100%(24/24)及83.33%(5/6)。平均手术时间为(13.03±3.61)min,平均有效辐射剂量为(7.95±4.57)mSv。活检术后CBCT复查发现气胸6例(6/30,20.00%),咯血3例(3/30,10.00%)。结论CBCT联合iGuide引导系统引导下PTNB具有较高诊断准确率和安全性以及合理的辐射暴露。

Objective To observe the clinical value of cone-beam computed tomography （CBCT） combined with iGuide system in percutaneous transthoracic needle biopsy （PTNB） of pulmonary lesions. Methods A total of 30 patients with solitary lung lesion underwent PTNB procedures were enrolled. The needle path was planned with iGuide system and 3D CT-like MPR images after CBCT. A coaxial system with 18-gauge cutting needle was used for biopsy. Procedure related data, complications and radiation exposure of patients were recorded. Results Among 30 patients, malignant lesions were found in 24, and benign lesions were in 6 patients. On PTNB, 28 patients were correctly diagnosed, 1 case was with insufficient samples but obtained correct pathologic result with second biopsy, 1 case was false-negative finding. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of PTNB in diagnosis of lung diseases was 96.67% （29/30）, 96.00% （24/25）, 100% （5/5）, 100% （24/24） and 83.33% （5/6）, respectively. The mean procedure time was （13.03±3.61）min, and exposure dose was （7.95±4.57）mSv. After PTNB procedures, pneumothorax and hemoptysis occurred in 6 （6/30, 20.00%） and 3 （3/30, 10.00%） patients, respectively. Conclusion CBCT combined with iGuide system for guiding PTNB is accurate and safe with reasonable radiation exposure.