CT引导胸穿肺活检对纤支镜阴性的肺部肿块诊断价值

The value of CT guiding transthoracic core needle biopsy in diagnosing pulmonary masses undetected by fiberoptic bronchoscopy

目的 :评价CT引导下经胸穿肺活检对纤维支气管镜检查阴性的肺部肿块患者的诊断价值。方法 :搜集 2 90例肺部肿块患者接受CT引导下经胸穿肺活检 ,其中 43例患者曾接受过纤维支气管镜检查 ,且检查结果为阴性 ,回顾性分析了该 43例患者的病理结果、肿块大小和穿刺并发症情况。结果 :发现恶性 2 6例 (腺癌 11例、鳞癌 8例、支气管肺泡癌 3例、未分化癌和腺鳞癌各 2例 ) ;良性 4例 (结核 2例、结节病 1例、炎性假瘤 1例 ) ;仍有 13例未能明确结果 ,该 13例中有6例因诊断或治疗的原因行手术治疗 ,发现 5例为恶性 (鳞癌 2例、未分化癌 1例、小细胞癌 1例、腺癌 1例 ) ,1例为良性病变 (结核 )。结论 :CT引导下经胸穿肺活检对纤维支气管镜检查阴性的肺部肿块患者有很高的临床价值 ,它的明确诊断率与部位关系不大 。

Objective:To assess the value of CT guiding transthoracic core needle biopsy (TNB) in patients with pulmonary masses undetected by fiberoptic bronchoscopy (FOB).Methods:290 patients with pulmonary masses underwent TNB.Of them 43 patients had previous FOB examination with negative or indeterminate findings.In the 43 cases with pathological findings,the size of tumor and complications caused by CT guiding TNB were retrospectively analyzed.Results:26 cases had malignant tumors including adenocarcinoma(n=11),squamous cell carcinoma(n=8),alveolar cell carcinoma(n=3),undifferentiated carcinoma(n=2) and adenosquamous carcinoma(n=2).4 had benign lesions such as tuberculosis (n=2),sarcoidosis(n=1) and inflammatory pseudotumor(n=1).A diagnosis,however,was not made by the TNB in the remaining 13 patients,of which 6 underwent thoracotomy.From these 6 cases 5 were found malignancy including squamous carcinoma(n=2),undifferentiated carcinoma(n=1),small cell undifferentiated carcinoma(n=1) and adenocarcinoma(n=1),and 1 was benign(tuberculosis).Conclusion:CT guiding TNB offers a high yield for diagnosis in those patients with pulmonary mass undetected by FOB.Results were not influenced by location, but correlated well with size of the target lesions in the lung.