CT引导下经皮肺穿刺活检对不同大小肺结节的诊断效能及并发症相关因素分析

Diagnostic accuracy and analysis of complication related factors of CT-guided percutaneous core needle biopsy of pulmonary nodules of different sizes

目的:CT引导下经皮肺穿刺活检对不同大小肺结节的诊断效能,并分析并发症的相关影响因素。方法:回顾性分析2014年9月-2018年9月CT引导下经皮肺穿刺活检的202例患者的临床及穿刺数据资料。按结节大小分为直径(D)≤10 mm组、10 mm<D≤20 mm组、20 mm<D≤30 mm组和D>30 mm组,分别统计各组穿刺活检诊断符合率。分别统计患者的年龄、性别、病灶大小、病灶密度、穿刺针穿越肺组织距离、取材组织数量等相关影响因素,采用χ^2检验和Mann-Whitney U检验分析各因素组各并发症发生率的差异,Logistic回归分析并发症发生的危险因素。结果:所有病例均取材满意并进行组织病理学检查,各组诊断符合率分别为85.71%、84.13%、83.64%和93.65%,差异无统计学意义;气胸的发生率为18.32%(37/202),肺出血的发生率为19.80%(40/202),咯血的发生率为0.99%(2/202);影响气胸发生率的因素包括年龄(OR=1.037,95%CI:1.001~1.074,P=0.042)及穿刺针穿越肺组织距离(OR=1.030,95%CI:1.009~1.052,P=0.006),且气胸发生率与两者均存在正相关;影响肺出血发生率的因素包括结节大小(OR=0.935,95%CI:0.895~0.977,P=0.003)及穿刺针穿越肺组织距离(OR=1.035,95%CI:1.013~1.058,P=0.002),且肺出血发生率与结节大小呈负相关,与穿刺针穿越肺组织距离呈正相关。所有病例均未发生感染、针道种植转移及空气栓塞等严重并发症。结论:CT引导肺穿刺活检是安全、有效获得病理诊断的手段,适用于不同大小肺结节,具有可接受的较低的并发症发生率。

Objective:To evaluate the diagnostic accuracy of CT-guided percutaneous core needle biopsy(CT-CNB)of pulmonary nodules of different sizes,and the factors that might affect the complications.Methods:This was a retrospective single-center study of 202 consecutive patients undergoing CT-CNB of pulmonary nodules between September 2014 and September 2018.The 202 cases were divided into 4 groups based on the nodule size:D≤10mm group,10mm<D≤20mm group,20mm<D≤30mm group and D>30mm group,and the diagnostic accuracy of each group was counted.The complication related factors such as patient's age,gender,lesion size,lesion density,the depth of puncture needle,the number of puncture tissues and other related factors were divided into different levels.The difference of complication incidence rate was analyzed by Chi-square analysis and Mann-Whitney U test.Risk factors was analyzed by Logistic regression.Results:All cases were satisfied in percutaneous biopsy and underwent histopathological examination.The diagnostic accuracy of each group was 85.71%,84.13%,83.64%and 93.65%,respectively.No statistically significant differences between the four groups.The incidence of pneumothorax,pulmonary hemorrhage,and haemoptysis were 18.32%(37/202),19.80%(40/202),and 1%(2/202),respectively.The factors affecting the incidence of pneumothorax included age(OR=1.037,95%CI:1.001~1.074,P=0.042)and the depth of puncture needle(OR=1.030,95%CI:1.009~1.052,P=0.006),which positively correlated with the incidence of pneumothorax;the factors affecting the incidence of pulmonary hemorrhage included the size of the nodule(OR=0.935,95%CI:0.895~0.977,P=0.003)and the depth of puncture needle(OR=1.035,95%CI:1.013~1.058,P=0.002).The incidence of pulmonary hemorrhage was negatively correlated with the size of the nodule,but positively correlated with the depth of puncture needle.No serious complications such as infection,needle transplantation and air embolism occurred in all cases.Conclusion:CT-CNB is a useful,safe and effective method to obtain pathological diagnosis,which can be used in pulmonary nodules of different sizes with an acceptable low risk of complications.