影响CT导引下胸部病变穿刺活检诊断正确率的因素分析

CT-guided percutaneous transthoracic aspiration biopsy of chest lesions: factors influencing the diagnostic accuracy

目的 探讨影响CT导引下胸部病变穿刺活检诊断正确率的因素。方法 收集 2 4 4例曾行胸部病变CT导引下穿刺活检病人的手术病理和临床随访资料 ,采用单因素统计分析和多元逐步Logistic回归分析方法 ,分析病人相关因素 (性别、年龄、有无肺气肿 )、病灶相关因素 (病灶的良恶性、大小、位置、深度及有无空腔 )和操作相关因素 (病人的体位 )对活检诊断正确率的影响。结果2 4 4例胸部病变最终诊断 16 5例为恶性、79例为良性 ,CT导引下穿刺活检诊断正确率为 82 4 % (2 0 1/2 4 4 )。单因素统计分析显示CT导引下穿刺活检对良、恶性病变诊断正确率分别为 6 9 6 % (5 5 / 79)和88 5 % (14 6 / 16 5 ) ,χ2 =13 0 96 ,P <0 0 1;诊断正确组和非正确组病灶大小分别为 4 0cm± 1 8cm和3 1cm± 1 4cm ,F =8 80 5 ,P <0 0 1。多元逐步Logistic回归分析显示病灶良恶性 (回归系数为0 32 0 ,Waldχ2 =7 12 6 ,P <0 0 1)和病灶大小 (回归系数为 1 114 ,Waldχ2 =4 95 1,P <0 0 5 )被列入回归方程。结论 病灶的良恶性和大小是影响CT导引下胸部病变穿刺活检诊断正确率的主要因素。

Objective To investigate the factors influencing the diagnostic accuracy of CT guided percutaneous transthoracic aspiration biopsy of chest lesions Methods Data of pathology and clinical follow up of 224 patients who had undergone CT guided percutaneous transthoracic biopsy were collected Univariate analysis and multivariate stepwise Logistic regression analysis were made to study the influence of the patient related factors (sex, age, and presence of emphysema), lesion related factors (histology, size, location, depth, and presence of cavity discovered by CT), and procedure factor (posture of patient during operation) on the diagnostic accuracy of CT guided biopsy Results (1) One hundred and sixty five lesions were diagnosed as malignant and 79 lesions as benign The accuracy rate of CT guided biopsy was 82 4% (201/244) Univariate analysis showed that the diagnostic accuracy rates of CT guided biopsy for malignant and benign lesions were 88 5% and 69 6% respectively ( χ 2=13 096, P <0 01) The mean diameters of the lesions with correct diagnosis and of those misdiagnosed were 4 0 cm±1 8 cm and 3 1 cm±1 4 cm respectively ( F =8 805, P <0 01) (2) Multivariate stepwise Logistic regression analysis showed that among the various factors only histology (regression coefficient=0 320, Wald χ 2=7 126, P <0 01) and size (regression coefficient=1 114, Wald χ 2=4 951, P <0 05) were significantly associated with diagnostic accuracy Conclusion Histology and size of lesion are the determining factors for diagnostic accuracy of CT guided transcutaneous thoracic needle aspiration biopsy