CT引导下经皮肺穿刺活检的临床应用

Clinical application of CT-guided percutaneous needle biopsy of lung

目的 探讨经皮肺穿刺活检术对肺部疾病诊断的应用价值和安全性。方法 回顾分析2013年6月至2016年10月CT引导下经皮肺活检204例患者的212次穿刺数据资料。结果 在204例患者中,孤立团块状病变107例,单发、多发结节性病变32例,完全肺实变54例,磨玻璃样病灶11例。穿刺成功率为91.0%(193/212),获得病理学诊断177例,准确率为91.7%(177/193);肿瘤性病变121例,非肿瘤56例。团块状病变组肺穿刺病理诊断率为91.6%(98/107),未明确诊断率为8.4%(9/107);结节组病理诊断率为84.4%(27/32),未明确诊断率为3.1%(1/32);完全肺实变组病理诊断率为83.4%(45/54),未明确诊断率为9.3%(5/54);磨玻璃样病灶组病理诊断率为63.6%(7/11),未明确诊断率为9.1%(1/11)。团块组病理诊断率高于磨玻璃样病灶组,差异有统计学意义(P<0.05);团块组与结节组和完全实变组之间病理诊断率差异无统计学意义(P>0.05)。共165例患者临床随访成功,得出经皮肺活检诊断肿瘤性疾病灵敏度为90.5%(114/126),特异度为100%(39/39)。经皮肺活检并发症为气胸发生率12.3%(26/212)、出血发生率为14.6%(31/212)。结论 (1)CT引导下经皮肺穿刺活检对肺内病变诊断的病理诊断率及准确性较高,并发症发生率低,安全性高;(2)对于肺部团块状病灶经皮肺活检病理病理诊断率高于磨玻璃样病变影,但是结节状、完全实变性及磨玻璃样病灶同样有较高的病理诊断率;(3)经皮肺活检对于肿瘤性病变诊断具有较高的灵敏度及特异度。

Objective To discuss the application value and safety of CT-guided percutaneous needle biopsy of lung in diagnosing pulmonary diseases. Methods The clinical data of a total of 204 patients with pulmonary lesions, who received CT-guided percutaneous lung biopsy （212 punctures in total） during the period from June 2013 to October 2016, were retrospectively analyzed. Results In the 204 patients, the pulmonary lesions presented as solitary mass （n=107）, single or multiple nodular lesions （n=32）, complete consolidation shadow of the lung （n=54） or ground-glass opacity （GGO） lesion （n=11 ）. The success rate of puncturing was 91.0% （193/212）, and the pathological diagnosis was obtained in 177 patients with the accuracy rate being 91.7% （177/193）. Neoplastic lesion was detected in 121 patients and non-neoplastic lesion was observed in 56 patients. The pathological diagnosis rate of lung biopsy tissue for pulmonary solitary mass was 91.6% （98/107） and the uncertain diagnosis was 8.4% （9/107）. The pathological diagnosis rate of lung biopsy tissue for pulmonary nodules was 84.4%（27/32） and the uncertain diagnosis was 3.1% （1/32）. The pathological diagnosis rate of lung biopsy tissue for complete lung consolidation was 83.4% （45/54） and the uncertain diagnosis was 9.3% （5/54）. The pathological diagnosis rate of lung biopsy tissue for GGO was 63.6% （7/11） and the uncertain diagnosis was 9.1% （1/11）. The pathological diagnosis rate of pulmonary solitary mass group was remarkably higher than that of GGO group, and the difference was statistically significant （P〈0.05）. No statistically significant difference in pathological diagnosis rate existed between pulmonary solitary mass group and complete lung consolidation group （P〉0.05）. A total of 165 patients were successfully followed up. The sensitivity and the specificity of percutaneous lung biopsy for the diagnosis of neoplastic lesions were 90.5% （114/126） and 100% （39/39） respectively. The complications included pneumothorax （12.3%, 26/212） and haemorrhage （14.6%, 31/212）. Conclusion ①For the diagnosis of pulmonary lesions, CT- guided percutaneous needle biopsy of lung has higher pathological diagnosis rate, higher accuracy, less complications and higher safety. ②The pathological diagnosis rate of CT-guided percutaneous lung biopsy tissue for pulmonary solitary mass is higher than that for GGO, although it also has the same higher pathological diagnosis rate for pulmonary nodules, complete lung consolidation and GGO lesions. ③CT-guided percutaneous needle biopsy of lung carries higher sensitivity and specificity for pulmonary neoplastic lesions.