CT引导≤2cm肺小结节18G粗针切割/20G细针抽吸穿刺活检临床分析

CT-guided transthoracic needle biopsy of small(≤2 cm) pulmonary nodules using 18 G coarse cutting needle or 20 G fine aspiration needle: a comparative analysis

目的探讨CT引导下经皮粗针(18G)切割活检与细针(20G)抽吸活检术两种方法在≤2cm的肺小结节诊断中的价值及安全性。方法回顾分析我科85例CT引导经皮肺活检临床资料(粗针组31例,细针组54例),比较不同直径活检针穿刺活检成功率、并发症及病理结果等。结果 85例病例总技术成功率100%,总取材成功率92. 9%,总肿瘤特异性检出率52. 9%,总肿瘤确诊率50. 6%。18G粗针组取材成功率、肿瘤特异性检出率和肿瘤确诊率高于20G细针组,分别为100%,74. 2%,70. 9%和85. 2%,50%,38. 9%,P值分别为0. 024,0. 003,0. 000。两组间并发症如气胸、肺出血、咳血发生率无统计学差异,P值均大于0. 05。结论对于≤2cm肺小结节,CT引导下18G粗针切割活检肿瘤检出率及肿瘤确诊率高于20G细针抽吸活检,气胸、肺出血等并发症发生风险与细针组相仿,是一种安全有效、准确性高的临床诊断方法。

Objective To explore the value and safety of CT guided needle biopsy in the diagnosis of small pulmonary nodules（≤2 cm） using 18 G coarse cutting needle or 20 G fine aspiration needle. Methods 85 patients with small pulmonary nodules who had been under CT-guided needle biopsy（18 G coarse cutting needle,n = 31,fine aspiration needle,n = 54） had been included this retrospective analysis. The rate of technique success,complications,and pathological findings and others between two groups had been compared. Results For all the included 85 patients who had been under CT guided needle biopsy,the rate of total technical success rate was 100%,the rate of total pathological sampling success was 92. 9%,the rate of total tumor specific detection rate was 52. 9% and the rate of tumor diagnosis was 50. 6%. Sub-analysis indicated that the rates of pathological sampling,tumor specific detection and tumor diagnosis in 18 coarse cutting needle group were higher than 20 G fine aspiration needle group,the rates of pathological sampling,tumor specific detection and tumor diagnosis were 100%,74. 2%,70. 9% for 18 G coarse cutting needle group and 85. 2%,50%,38. 9% for 20 G fine needle group,the differences were significant and p values were 0. 024,0. 003,0. 000. The differences of rate of complications such as pneumothorax,empsyxis and hemoptysis between two groups were not significant,and P values were more than 0. 05. Conclusion For small pulmonary nodules ≤2 cm in patients,CT guided 18 G coarse cutting needle biopsy showed higher rates of tumor specific detection and tumor diagnosis while showed similar rates of complication including pneumothorax and empsyxis when compared with 20 G fine needle aspiration biopsy. CTguided 18 G coarse cutting needle biopsy was a safe and effective diagnostic method for small pulmonary nodules with higher accuracy.