不同肺活检方式在老年肺周围型肿块诊断中的价值

Value of different lung biopsy methods in diagnosis of peripheral lung masses in the elderly

目的研究不同肺活检方式在肺周围型肿块诊断中的价值及应用安全性。方法选择2019年6月至2021年6月邯郸市第四医院收治的经影像学诊断为肺周围型病变的286例老年患者为研究对象,根据肺活检方式,将患者分为经皮肺穿刺活检(TNLB)组(n=165)与经支气管镜透壁肺活检(TBLB)组(n=121)。以病理检查及随访结果作为“金标准”,采用McNemar检验,计算TNLB、TBLB在诊断肺周围型肿块性质中的灵敏度、特异度、准确度、阳性预测值及阴性预测值。采用SPSS 19.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ^(2)检验进行组间比较。结果TNLB组165例患者中,阳性者51例,阴性者114例,阴性者中有9例经随访及手术病理检查证实为恶性病变。TNLB在诊断肺周围型肿块中的灵敏度、特异度、准确度、阳性预测值及阴性预测值分别为:85.00%、100.00%、94.55%、100.00%和92.11%。TBLB组121例患者中,阳性者23例,阴性者98例,阴性者中有16例后经随访证实为恶性病变。TBLB在诊断肺周围型肿块中的灵敏度、特异度、准确度、阳性预测值及阴性预测值分别为58.97%、100.00%、86.78%、100.00%和83.67%。TNLB活检正确率高于TBLB,差异有统计学意义(94.55%和86.78%,P<0.05)。TNLB并发症发生率高于TBLB,差异有统计学意义(24.85%和11.57%,P<0.05)。TBLB对直径≥4 cm病灶的阳性检出率高于直径<4 cm病灶,差异有统计学意义(24.69%和7.50%,P<0.05);对于直径<4 cm的病灶,TNLB阳性检出率高于TBLB,差异有统计学意义(26.67%和7.50%,P<0.05)。结论TLNB具有定位准确、活检正确率高的优势,但术后并发症较多;对于肺部耐受力差,但病灶直径较大、靠近中央气道的肺周围型肿块老年患者,可将TBLB作为首选活检方式,以提高活检安全性。

Objective To investigate the value and safety of different lung biopsy methods in the diagnosis of peripheral lung masses.Methods A total of 286 elderly patients with peripheral lung lesions diagnosed by radiology in our hospital from June 2019 to June 2021 were enrolled as the study subjects.According to the methods of lung biopsy,they were divided into transthoracic needle lung biopsy group(TNLB group,n=165)and transbronchial lung biopsy group(TBLB group,n=121).McNemar test was used to calculate the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of TNLB and TBLB in the diagnosis of properties of peripheral lung masses by taking pathological examination and follow-up result as the"gold standard".SPSS statistics 19.0 was used for data analysis.Student′s t test or Chi-square test was used for intergroup comparison depending on different data type.Results For the 165 patients from the TNLB group,51 cases had positive and 114 cases had negative results after TNLB,and 9 negative cases were confirmed to be malignant by follow-up and surgical pathology.Among 121 patients receiving TBLB,23 cases got positive and 98 cases negative results,and among the negative cases,16 cases were confirmed to be malignant by follow-up examination.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value in the diagnosis of peripheral lung masses were 85.00%,100.00%,94.55%,100.00%and 92.11%for TNLB,and 58.97%,100.00%,86.78%,100.00%and 83.67%for TBLB.The biopsy accuracy rate was significantly higher in TNLB than TBLB(94.55%vs 86.78%,P<0.05).TNLB had higher incidence rate of complications than TBLB(24.85%vs 11.57%,P<0.05).TBLB had obviously higher positive detection rate for lesions≥4 cm in diameter than those with diameter<4 cm(24.69%vs 7.50%,P<0.05).With regard to lesions<4 cm in diameter,the positive detection rate of TNLB was higher than that of TBLB(26.67%vs 7.50%,P<0.05).Conclusion TLNB has the advantages of accurate localization and high biopsy accuracy rate,but has more postoperative complications.TBLB can be used as a preferred biopsy method to improve the safety of biopsy for the elderly patients with peripheral lung masses,who has poor lung tolerance but large lesion diameter and lesion close to the central airway.