超声造影和CT引导下经皮穿刺活检在周围型肺肿块诊断中临床价值的比较

Comparative study on the clinical value of contrast-enhanced ultrasound-and CT-guided percutaneous puncture biopsy in peripheral lung masses

目的比较超声造影(CEUS)和CT引导下经皮穿刺活检在周围型肺肿块诊断中的临床价值。方法回顾分析2019年10月至2021年12月在南通大学附属肿瘤医院接受穿刺活检的90例周围型肺肿块患者的临床资料。按照穿刺引导方式的不同,分为CEUS引导的经皮穿刺活检组(CEUS组,40例)和CT引导的经皮穿刺活检组(CT组,50例),并评价两组在穿刺成功率、并发症发生率等方面的差异。同时,检测微血管密度(MVD)与CEUS参数之间的相关性。结果CEUS组穿刺成功率高于CT组,但两组间差异不具有统计学意义[97.5%(39/40)vs.92.0%(46/50),P=0.337];CEUS组并发症发生率明显低于CT组[0(0/40)vs.12.0%(6/50),P=0.032]。而且与CT组相比,CEUS组穿刺次数少[(2.0±1.6)次vs.(2.8±1.2)次,t=-2.43,P=0.018],穿刺时长短[(7.6±2.5)min vs.(15.3±2.6)min,t=-8.86,P<0.001],手术费用低[(1308.4±545.6)元vs.(2046.4±645.3)元,t=-2.01,P=0.046]。肺腺癌的MVD、CEUS峰值强度和增强指数均高于鳞状细胞癌[(25.4±4.9)个/HP vs.(16.6±7.3)个/HP,t=3.43,P=0.002;(46.9±6.5)db vs.(36.8±5.4)db,t=4.12,P<0.001;5.2±1.4 vs.4.1±1.2,t=3.27,P=0.006]。肺鳞状细胞癌和肺腺癌的CEUS峰值强度、增强指数均与各自病灶内MVD呈正相关(鳞状细胞癌:r=0.66,P<0.001;r=0.56,P<0.001;腺癌:r=0.62,P<0.001;r=0.70,P<0.001)。结论与CT相比,CEUS引导的经皮穿刺活检在周围型肺肿块诊断中并没有获得更高的成功率,但降低了并发症发生率,同时具有用时少、费用低、无辐射、可实时动态引导等优点,值得在临床中加强推广。另外,肺腺癌、鳞状细胞癌CEUS定量参数与MVD之间存在相关性,可能作为诊断依据。

Objective To compare the clinical value of contrast-enhanced ultrasound(CEUS)-and CT-guided percutaneous puncture biopsy in the diagnosis of peripheral lung masses.Methods The clinical data of 90 patients with peripheral lung masses who underwent puncture biopsy in Tumor Hospital Affiliated to Nantong University from October 2019 to December 2021 were retrospectively analyzed.According to different puncture guidance methods,patients were divided into CEUS-guided percutaneous puncture biopsy group(CEUS group,n=40)and the CT-guided percutaneous puncture biopsy group(CT group,n=50),and the differences in puncture success rates,complication rates and other factors between the two groups were evaluated.Meanwhile,the correlations between microvascular density(MVD)and CEUS parameters were detected.Results The puncture success rate in the CEUS group was higher than that in the CT group,but there was no statistically significant difference[97.5%(39/40)vs.92.0%(46/50),P=0.337],and the complication rate in the CEUS group was significantly lower than that in the CT group[0(0/40)vs.12.0%(6/50),P=0.032].Compared with the CT group,the CEUS group has fewer punctures[(2.0±1.6)times vs.(2.8±1.2)times,t=-2.43,P=0.018],shorter duration[(7.6±2.5)min vs.(15.3±2.6)min,t=-8.86,P<0.001]and lower cost of surgery[(1308.4±545.6)yuan vs.(2046.4±645.3)yuan,t=-2.01,P=0.046].The MVD,CEUS peak intensity and enhancement index of lung adenocarcinoma were higher than those of squamous cell carcinoma[(25.4±4.9)/HP)vs.(16.6±7.3)/HP,t=3.43,P=0.002;(46.9±6.5)db vs.(36.8±5.4)db,t=4.12,P<0.001;5.2±1.4 vs.4.1±1.2,t=3.27,P=0.006].The peak intensity and intensity index of CEUS in lung adenocarcinoma or squamous cell carcinoma were positively correlated with itself MVD(squamous cell carcinoma:r=0.66,P<0.001;r=0.56,P<0.001;adenocarcinoma:r=0.62,P<0.001;r=0.70,P<0.001).Conclusion Although CEUS-guided percutaneous puncture biopsy does not achieve a higher puncture success rate in the diagnosis of peripheral lung masses compared to CT,it really decreases the complication rate,and has the advantages of less time,low cost,no radiation and real-time dynamic monitoring,which is worth promoting in clinic.Moreover,there are correlations between CEUS quantitative parameters of adenocarcinoma and squamous cell carcinoma of the lung and MVD,which may be useful for diagnosis.