快速现场细胞学在CT引导下经皮穿刺活检肺外周结节中的应用

Rapid on-site evaluation in CT-guided percutaneous biopsy of peripheral pulmonary nodules

目的评估快速现场细胞学(ROSE)在CT引导下经皮穿刺活检肺外周结节(直径≤2.0 cm)中的应用价值。方法回顾性分析108例接受CT引导下经皮穿刺活检术的肺结节(直径≤2.0 cm)患者,包括ROSE组(58例)和常规组(50例),比较2组取材充分性、诊断准确率、二次活检率及并发症,并统计ROSE与HE染色的一致性。结果ROSE组取材充分性(54/58,93.10%)和诊断准确率(52/58,89.66%)均高于常规组[78.00%(39/50),74.00%(37/50);P均<0.05)],二次活检率(4/58,6.90%)低于常规组(11/50,22.00%,P<0.05)。2组气胸、出血发生率差异均无统计学意义[13.79%(8/58)vs 18.00%(9/50),39.66%(23/58)vs 40.00%(20/50),P均>0.05]。ROSE与组织病理对良恶性病变的一致性分别为91.30%(21/23)和93.33%(28/30)。结论ROSE可在不延长手术时间、不增加并发症的前提下指导CT引导下经皮穿刺取材,可保证取材的充分性并提高诊断准确率,降低二次穿刺活检率,与组织病理一致性好,可获得即刻诊断。

Objective To observe the value of rapid on-site evaluation(ROSE)in CT-guided percutaneous lung biopsy of peripheral pulmonary nodules(≤2 cm).Methods A total of 108 patients with pulmonary nodules who underwent CT-guided percutaneous lung biopsy were retrospectively analyzed.According to the presence or absence of ROSE,they were divided into ROSE group(n=58)and conventional group(n=50).The adequacy of sampling,diagnostic accuracy,complications,secondary biopsy rate and statistical consistency were compared between ROSE and histopathology.Results The adequacy and diagnostic accuracy in ROSE group were higher than those in conventional group(93.10%[54/58]vs 78.00%[39/50],89.66%[52/58]vs 74.00%[37/50],both P<0.05),while the second biopsy rate in ROSE group was lower than in conventional group(6.90%[4/58]vs 22.00%[11/50],P<0.05).There was no statistical difference of incidence of pneumothorax nor bleeding between 2 groups(13.79%[8/58]vs 18.00%[9/50],39.66%[23/58]vs 40.00%[20/50],both P>0.05).The consistency of ROSE and histopathology for benign and malignant lesions was 91.30%(21/23)and 93.33%(28/30),respectively.Conclusion ROSE can guide puncture sampling without prolonging operation time and increasing complications,so as to ensure the adequacy of sampling,improve diagnostic accuracy and reduce the rate of secondary puncture during biopsy of pulmonary nodules,which has good consistency with histopathology and can make immediate diagnosis.