前纵隔病变的CT引导经皮切割针穿刺——非经胸骨的活检

CT-guided Percutaneous Non-transsternal Cutting-needle Biopsy for Anterior Mediastinal Lesions

目的 探讨非经胸骨的前纵隔病灶切割针穿刺的方法、技术、临床价值及其并发症。资料与方法 回顾性分析 1992～ 2 0 0 1年间共对 39例前纵隔病变行CT引导下的非经胸骨的经皮穿刺。所用穿刺针为 16、18、19和 2 0G自动芯状活检枪。所有病例同时行细胞学和组织学检查 ,并分析其准确性和并发症。结果 35例得到病理诊断 ,包括淋巴瘤 6例 ,转移性肿瘤 5例 (腺癌 2例 ,鳞癌 2例 ,低分化癌 1例 ) ,恶性肿瘤 (未能分型 ) 5例 ,胸腺瘤 4例 ,腺癌、鳞癌、胸内甲状腺、结核、结节病各 2例 ,恶性畸胎瘤、内胚窦瘤、小圆细胞瘤、Castleman’s病、纵隔血肿各 1例。失败 4例 ,原因为切割组织太少 (2例 )、肿瘤液化坏死 (1例 )和抽吸物为血液 (1例 )。随后确诊为淋巴瘤 3例 ,另 1例颈部活检为转移性低分化癌 ,系假阴性。并发症包括皮下血肿 3例 ,纵隔血肿 2例 ,纵隔气肿 2例。准确率为89.7% (35 / 39) ,假阴性率为 10 .3% (4/ 39) ,总的并发症发生率为 17.9% (7/ 39)。结论 CT引导下非经胸骨的经皮前纵隔穿刺适用于前纵隔各个部位的病灶 。

Objective To discuss the manipulation, technique, clinical value and complication of CT guided percutaneous non transsternal biopsy with an automatic cutting needle for anterior mediastinal lesions.Materials and Methods Using 16, 18, 19 or 20 gauge needle, the procedure was performed in 39 cases with anterior mediastinal masses. Cytological and histopathological examinations were done in all cases. The diagnostic accuracy and complications were analyzed. Results Pathological diagnosis was obtained in 35 cases, including lymphoma (n=6), metastases (n=5, including 2 adenocarcinoma, 2 squamous carcinoma and 1 poor differentiated carcinoma), thymoma (n=4), adenocarcinoma (n=2), squamous carcinoma (n=2), intrathoracic thyroid gland (n=2), tuberculosis (n=2), sarcoidosis (n=2), malignant teratoma (n=1), endodermal sinus tumor (n=1), small round cell tumor (n=1), Castleman's disease (n=1) and mediastinal hematoma (n=1). The remaining 4 cases failed to get pathological results due to little specimen (n=2), liquefaction necrosis of the tumor (n=1) or only blood being aspirated (n=1). Of the above 4 cases, the diagnosis was eventually verified as lymphoma (n=3) or metastatic poor differentiated carcinoma (n=1). The complications included subcutaneous hematoma (n=3), mediastinal hematoma (n=2) and mediastinal emphysema (n=2). The diagnostic accuracy was 89.7% (35/39), and the false negative rate was 10.3% (4/39). The total complication occurrence was 17.9% (7/39).Conclusion CT guided percutaneous non transsternal biopsy with an automatic cutting needle is a simple and safe technique suitable for making qualitative diagnosis of the lesions located at any part of the anterior mediastinum.