基于18F-FDG PET/CT代谢活性指导下行CT引导经皮穿刺肺活检的临床应用价值

The clinical application value of CT-guided percutaneous lung biopsy guided by 18F-FDG PET/CT metabolic activity

目的:探讨基于18F-脱氧葡萄糖(18F-FDG)PET、代谢活性指导下行CT引导经皮穿刺肺活检的临床应用价值。方法:选取2016年1月-2020年6月北部战区总医院收治的肺内占位患者320例为研究对象。320例患者根据是否有18F-FDG PET/CT图像引导将患者分为两组,A组160例患者行单纯增强CT检查后肺穿刺活检,B组160例患者分别行18F-FDG PET/CT全身检查及增强CT检查,然后再根据病灶代谢情况,选择高代谢区进行穿刺活检。比较单纯增强CT引导下及18F-FDG PET/CT、增强CT两种显像方法联合18F-FDG高代谢区定位指导经皮穿刺肺活检对病理诊断结果 的灵敏度、特异度、准确率等,以及与术后病理最终诊断或长期随诊(6月以上)的临床诊断一致性。结果:A组160例患者中,恶性病变115例,良性病变19例,诊断不明病变26例,诊断的灵敏度85.8%、特异度93.9%、准确率87.2%、B组160例患者中,恶性病变132例,良性病变21例,诊断不明病变7例,诊断的灵敏度95.8%、特异度100%、准确率98.2%、两组诊断灵敏度、特异度、准确率差异有统计学意义(P<0.05);另外A组患者并发症中出现肺内少量出血28例,少量气胸32例(3例出现临床症状,给予胸腔闭式引流后气胸吸收),大咯血3例,空气栓塞1例,B组并发症中肺内少量出血16例,少量气胸20例,无大咯血及空气栓塞出现;两组并发症差异有统计学意义(P<0.05),B组所获得诊断与最终诊断具有较高的一致性(k=0.747),两者联合具有极好的一致性(k=0.862)。结论:基于PET/CT代谢活性指导下行CT引导经皮穿刺肺活检对肺内病变的诊断具有较高的灵敏度、特异度及准确率,可降低出血、气胸、大咯血及空气栓塞等并发症发生率,具有较高的临床应用价值。

Objective: To explore the clinical value of CT-guided percutaneous lung biopsy based on18F-fludeoxyglucose(18F-FDG) PET and metabolic activity guidance. Methods: From January 2016 to June 2020, 320 patients with pulmonary space occupying lesions treated in the Nuclear Medicine Discipline of General Hospital of Northern Theater Command were selected as the research objects. 320 patients were divided into two groups on average. 160 patients in group A underwent lung puncture biopsy after simple enhanced CT examination, and 160 patients in group B underwent18F-FDG PET/CT systemic examination and enhanced CT examination respectively, and were then selected for puncture biopsy in the high metabolic area according to the metabolism of the focus. The sensitivity, specificity, accuracy and complication rate of percuta-neous lung biopsy guided by simple enhanced CT and18F-FDG PET/CT and enhanced CT combined with biological target localization were compared, as well as the consistency with the final postoperative pathological diagnosis or long-term follow-up(more than 6 months). Results: Among the 160 patients in group A, there were 115 malignant lesions, 19 benign lesions and26 unknown lesions. The diagnostic sensitivity, specificity and accuracy were 85.8%, 93.9% and 87.2%, respectively. Among the 160 patients in group B, there were 132 malignant lesions, 21 benign lesions and 7 unknown lesions. The diagnostic sen-sitivity, specificity and accuracy were 95.8%, 100% and 98.2%, respectively. There was a significant difference in accuracy( P<0.05). In addition, in group A, 28 patients had a small amount of intrapulmonary hemorrhage, 32 patients had a small amount of pneumothorax(3 patients had clinical symptoms and were absorbed by pneumothorax after closed thoracic drainage), 3 pa-tients had massive hemoptysis, and 1 patient had air embolism. In group B, 16 patients had a small amount of intrapulmonary hemorrhage and 20 patients had a small amount of pneumothorax, without massive hemoptysis and air embolism. There was a significant difference in complications between the two groups(P<0.05). The diagnosis obtained in group B had high consistency with the final diagnosis(k=0.747), and the combination of the two had excellent consistency(k=0.862). Conclusion: CT-guided percutaneous lung biopsy based on PET/CT metabolic activity guidance has high sensitivity, specificity and accuracy in diag-nosing lung lesions, reducing the occurrence of complications, and has high clinical application value.