肺磨玻璃结节CT引导穿刺活检临床价值分析并文献复习

Clinical value analysis and literature review of CT guided puncture biopsy of pulmonary ground glass nodules

目的:总结肺磨玻璃结节(GGN)CT引导穿刺活检病例结果,结合文献报道,探讨CT引导穿刺活检对肺GGN病变的临床价值。方法:回顾性收集2017年6月至2021年8月间武汉大学中南医院肺GGN CT引导穿刺活检病例资料,以恶性GGN为阳性组、临床最终诊断为金标准,计算肺GGN穿刺活检诊断敏感性、特异性、准确率、诊断率及穿刺与手术病理亚型一致率,并结合文献资料评估穿刺活检的临床价值。结果:43例GGN符合纳入标准,男16例,女27例,平均年龄(63.4±10.9)岁。穿刺病理结果恶性38例,良性3例,2例无法诊断。穿刺活检诊断的敏感性为95.0%(38/40),特异性为100.0%(3/3),准确率为93.0%(40/43),诊断率为95.3(41/43)。穿刺明确诊断的GGN中,18例行手术治疗,穿刺与手术病理亚型一致率为66.7%(12/18)。术后气胸率34.9%、咯血率16.3%。结论:CT引导穿刺活检对肺GGN有较高的诊断敏感性、特异性、准确率及诊断率,是一种安全有效的方法。

Objective: To summarize the results of CT-guided puncture biopsy of pulmonary ground glass nodules(GGNs), and to explore the clinical value of CT-guided puncture biopsy of pulmonary GGNs with literature review. Methods: The data of patients with pulmonary GGN CT-guided puncture biopsy were retrospectively collected from June 2017 to August 2021 in Zhongnan Hospital of Wuhan University, with malignant GGNs identified by clinical final diagnosis as the positive group. The diagnostic sensitivity, specificity, accuracy, and diagnostic rate of lung GGNs puncture biopsy and the coincidence rate of puncture biopsy with surgical pathological subtype were calculated. Then the clinical value of puncture biopsy was evaluated based on literature data. Results: A total of 43 GGNs met the inclusion criteria, including 16 males and 27 females, with an average age of(63. 4±10. 9) years. Puncture pathology showed that 38 cases were malignant, 3 cases were benign, and 2 cases could not be diagnosed. The sensitivity, specificity, accuracy, and diagnostic rate of puncture biopsy were 95. 0%(38/40), 100. 0%(3/3), 93. 0%(40/43), and 95. 3(41/43), respectively. The postoperative pneumothorax rate was 34. 9% and hemoptysis rate was 16. 3%. Among the GGNs clearly diagnosed by puncture biopsy, 18 GGNs underwent surgical treatment, and the consistent rate of puncture biopsy with surgical pathological subtype was 66. 7%(12/18). Conclusion: CT-guided puncture biopsy of GGN has high diagnostic sensitivity, specificity and accuracy, which is a safe and effective method.