CT导向下纵隔肿瘤穿刺活检术

Mediastinal lesion:transthoracic needle biopsy with CT guidance

目的 :评价CT导向下纵隔肿瘤穿刺活检的临床应用价植。方法 :回顾性分析 74例纵隔病变CT导向下纵隔穿刺活检术。穿刺针采用 18GCHIBA针、18G切割针 ,74例均做病理组织学检查 ,8例作免疫组化。结果 :①病变部位前纵隔 62例 ,中纵隔 8例 ,后纵隔 4例 ;② 63例病理诊断明确 :胸腺瘤 16例 ,恶性淋巴瘤 12例 ,转移性腺癌 7例、鳞癌 4例、小细胞癌 2例 ,畸胎瘤、恶性精原细胞瘤各 5例、内胚窦癌 2例 ,神经纤维瘤、恶性神经鞘膜瘤、节细胞神经纤维瘤各 1例 ,3例诊断为小圆细胞恶性肿瘤 ,3例为异型细胞 ,1例诊断为结核 ;③ 11例病理诊断不确定 :临床诊断为恶性淋巴瘤 4例、纵隔淋巴结结核 1例 ,经手术病理诊断为胸腺瘤、纵隔脂肪瘤、血管肉瘤、纤维肉瘤各 1例 ,2例失访 ;④穿刺活检正确率为 85 .1%,假阴性率为 14 .9%,未见假阳性病例 ;⑤气胸发生率为 5 .4%,为少量气胸 ,3例术后痰带血丝 ,1例纵隔局限性血肿。结论

Objective:To evaluate the efficacy of CT guiding percutaneous transthoracic needle biopsy for mediastinal lesion.Methods:CT guided percutaneous biopsy of mediastinal lesions was performed in 74 cases with a 18 gauge Chiba or Trucut needle.Pathological examinations were done in all cases,and immunohistochemical cytologic methods were used in 8 cases.Results:①The location of lesions:in anterior mediastinum(n=62),in middle mediastinum(n=8),in posterior mediastinum(n=4).②Pathological diagnosis was established in 63 cases,including thymoma (n=16),lymphoma (n=12),metastases (n=13),adenocacinoma(n=7 ),squamous carcinoma (n=4),small cell carcinoma(n=2),teratoma(n=5),germ cell tumor(n=5),endodermal sinus tumor (n=2),neurofibroma (n=1),malignant neurilemmoma(n=1),ganglioneuroma (n=1),small round cell tumor (n=3),anaplastic histocyte (n=3),tuberculosis (n=1).③Uncertain diagnosis by pathology in 11 cases included clinically supected lymphoma (n=4) and tuberculosis (n=1);1 thymoma,1 lipoma,1 hemangiosarcoma and 1 fibrosarcoma was confirmed by surgical and pathological findings respectively,and 2 cases lost in follow up.④The diagnostic accuracy of percutaneous biopsy was 85.1%,and the false negative rate was 14.9%.⑤The complications included mild pneumothorax (n=4),bloody sputum (n=3),and mediastinal hematoma (n=1).Conclusion:Transthoracic needle biopsy of mediastinal lesion with CT guidance is a safe and valuable diagnostic procedure.