弹簧活检枪在胸部肿块活检中的应用

目的 :探讨应用弹簧活检枪行胸部肿块CT引导下穿刺活检的临床价值。材料和方法 :使用 15～ 18G弹簧活检枪在CT引导下对 42例胸部肿块 (肺 3 4例、纵隔 8例 )行穿刺活检术 ,标本行组织学、细胞学检查 ,活检结果与手术及随访结果对照。结果 :活检枪活检总准确性为 90 .5 %。肺部肿块中恶性肿瘤 3 0例、良性病变 4例 ,肺癌假阴性 3例 ,无假阳性 ;纵隔肿块中恶性 8例 ,1例淋巴瘤穿刺物难以定性。并发症发生率 2 1.4% ,其中气胸 6例、针道区少量出血 3例 ,除 1例气胸行闭式引流外均无需处理。结论 :使用弹簧活检枪行CT引导下胸部肿块穿刺活检准确、安全 ,临床价值高。     

使用切割针行经皮纵隔肿块穿刺活检术

探讨ＣＴ引导下使用切割针行经皮纵隔肿块穿刺活检术的临床价值。材料和方法：对３２例纵隔肿块,使用１６～１９Ｇ切割针在ＣＴ引导下施行穿刺活检术,分别进行细胞学和组织学检查。结果：诊断准确性为９３．８％,假阴性率６．１％。并发症包括气胸（３例）、肺内出血（５例）、纵隔内出血（３例）,其发生与穿刺路径有关;总体发生率为３４．４％（１１／３２）,均无需特殊处理。结论：ＣＴ引导下经眼纵隔肿块切割活检术诊断准确     

比较CT引导下两种穿刺针在经皮肺穿刺活检术中的临床应用

目的:比较CT引导下两种穿刺针在经皮肺穿刺活检中的差异.材料和方法:对照分析经手术证实的120例肺部肿物患者,使用细针穿刺和切割活检针术前经皮肺穿刺活检各60例,分析其确诊率、并发症的差异等.结果:120例肺部肿物患者在CT引导下经皮肺穿刺活检术,98例得到阳性结果,假阴性12例,敏感性为89.1%,特异性为100%.细针穿刺组敏感性88.8%(48/54);切割活检针组敏感性89.3%(50/56),两组间无统计学差异.气胸发生率为10.0%,痰中带血或咳血发生率为11.7%,两组间亦无差异.结论:CT引导下经皮肺穿刺活检术中,使用细针和切割活检针穿刺的阳性率和并发症无统计学差异.     

CT引导下经皮穿刺同轴细针活检术诊断纵隔占位性病变40例

目的 评价CT引导下经皮穿刺同轴细针活检术对纵隔占位性病变诊断的技术成功率、诊断正确率和安全性.方法 在CT引导下采用18G带芯穿刺针穿刺40例纵隔占位性病变,然后经18G穿刺针的外套针同轴引入20 G切割活检细针对纵隔病变行经皮同轴穿刺活检.结果 40例患者的纵隔占位性病变接受41次活检,其中1例患者先后接受2次穿刺活检.CT证实41次经皮穿刺的穿刺针皆位于纵隔占位病灶内,37次活检病理结果与临床最终诊断相一致.本组资料穿刺技术成功率100％,穿刺活检诊断准确率90.2％.2例出现少量气胸,肺组织压缩程度小于20％,随访过程中自行吸收,无其他穿刺相关并发症发生.结论 CT引导下经皮同轴穿刺活检术诊断纵隔占位性病变是安全、准确、微创的介入诊断技术.     

Precisa活检针在螺旋CT引导下经皮肺穿刺活检诊断肺部病变准确性的分析

目的 分析影响螺旋CT引导下应用Precisa活检针经皮肺穿刺活检诊断肺部病变准确率的因素.方法 回顾性分析87例螺旋CT定位引导下应用Precisa活检针经皮肺穿刺活检资料,对切取病变组织肉眼观与手术病理结果的关系,穿刺的成功率以及并发症进行分析.结果 病灶穿刺成功率100%.确定病理诊断78例(89.65%),未明确诊断9例;术后并发症发生率19.5%,其中气胸8例,局部出血5例,咯血2例,经相应处理后缓解.结论 螺旋CT引导下用Precisa活检针经皮肺穿刺活检成功率与病理诊断率高,可为临床治疗方法的选择提供可靠依据.     

螺旋CT引导下自动切割针系统在肺活检中的应用价值

目的 研究螺旋CT引导下，采用自动可分离切割针系统经皮穿刺活检的诊断价值。方法 螺旋CT引导，使用自动弹射活检枪、16G～21G可调式同轴切割针，对287例肺内结节性病灶行经皮穿刺肺活检。结果 262例获定性诊断，其中恶性病变195例，良性病变67例，定性诊断率为91.3％，气胸、咯血等轻微并发症为21.3％。结论 螺旋CT引导下自动可分离切割针系统是一种安全、准确、有效的肺球形病灶检查方法，值得临床推广。     

CT引导下经皮肺穿刺活检经验总结

目的：探讨CT导引下经皮肺穿刺活检的技术方法和影响诊断准确性的因素，防范并发症的心得。方法：回顾性分析36例肺内病变CT引导下经皮肺穿刺活检的技术方法，就如何提高穿刺准确性及影响诊断准确率的因素、防范并发症的心得进行讨论。结果：36例中，穿刺成功率100％，活检诊断准确率为30／36（83％）。3例发生轻度气胸。结论：CT引导下经皮肺穿刺活检术是安全的，可有效提高肺内病变的诊断准确性。但操作医生熟练的技术方法非常重要，并可以减少并发症的发生。     

CT导航下经皮肺小病灶穿刺活检的临床应用

目的探讨CT导航下肺小病灶经皮穿刺活检的临床应用价值。方法 56例肺内单发小结节病变(直径在0.8~2 cm)患者,在CT引导下应用18G自动活检针(或与之配套的带套管穿刺针)取材。均行组织病理学检查。结果 56例病例全部穿刺成功,53例肺小结节病变1次取材成功,成功率为94.64%,2例行2次取材成功,1例行3次取材成功。56例病理结果与手术或随访结果一致。该组7例出现少量气胸,1例中等量气胸,气胸发生率14.3%,10例肺出血,发生率17.9%,6例有少量咯血,1例中等量咯血,咯血发生率为12.5%。所有病例随访均未发生感染、肿瘤针道种植转移等并发症。结论 CT引导下自动切割针经皮活检肺小病灶(直径≤2 cm)诊断准确率高,并发症少,是一种安全、有效的临床诊断方法。     

CT导向下经皮穿刺肺活检对肺内结节性病变的诊断价值

目的：通过对60例CT导向下经皮肺内结节性病灶的活检分析，寻栈提高肺内结节性病灶经皮肺活检的一次性穿刺成功率和诊断准确性的方法。方法：回顾性分析60例有明确结果的经皮肺活检病例，分析其病灶离胸壁距离远近与肺内结节性病灶经皮肺活检一次性穿刺成功率的关系，及诊断准确性、并发症率及其影响因素。结果：对肺癌的准确率为89．2％，一次性穿刺成功率81.9％，较文献资料报道有所提高。结论：将CT定位技术与穿刺技术有效结合，可望在不增加并发症发生率的前提下，提高一次性穿刺成功率。     

CT引导下细针穿刺活检对肺部空洞性病变的诊断价值

目的 探讨CT引导下经皮细针穿刺活检在肺部空洞性肿块中的诊断价值.方法 97例肺内孤立性肿块或结节伴有空洞的患者,进行CT引导下经皮肺穿刺活检,以手术病理或1年随访的最终诊断为标准,计算CT穿刺活检的诊断准确率,比较不同病灶大小及空洞壁厚度下CT穿刺活检的诊断敏感度、特异度及准确率,并采用Logistic回归分析CT穿刺活检并发症的危险因素.结果 CT穿刺活检的敏感度、特异度及准确率分别为97.4％,90.0％及95.9％,不同大小病灶(直径＜2 cm或≥2 cm)、不同空洞壁厚度(＜5或≥5 mm)其敏感度、特异度及准确率无统计学差异(P＞0.05).9例(9.3％)CT穿刺后出现少量气胸,14例(14.4％)出现少许肺泡出血,穿刺并发症与病灶大小、空洞壁厚度、针道深度及穿刺针大小无相关性(P＞0.05).结论 CT引导下经皮细针穿刺活检安全,对肺部空洞性病变的诊断准确性高.     

CT透视引导下的纵隔小病灶穿刺活检的临床价值

目的探讨CT引导下纵隔小病灶穿刺活检技术及诊断价值。方法42例纵隔小病灶(小于3cm)在CT引导下采用自动切割式活检针穿刺活检。结果42例纵隔肿块穿刺活检病灶取材成功率97.65(41/42)。纵隔肿块穿刺活检的诊断准确率92.3%(39/42),对于恶性病变诊断准确率96.3%(26/ 27),良性病变为86.7%(13/15)。并发气胸2例(4.8%),纵隔少量出血1例(2.3%)。结论CT引导下穿刺活检是安全、有效的诊断手段,对于纵隔病变诊断的准确率高,CT引导下纵隔小病灶穿刺活检对纵隔病变的诊断和治疗具有重要意义。     

CT-guided cutting needle biopsy of lung lesions--safety and efficacy of an out-patient service

AIM: To determine the safety and efficacy of CT-guided cutting needle biopsy of lung lesions as an out-patient procedure. MATERIALS AND METHODS:A total of 185 consecutive biopsies were performed under CT guidance on 183 patients between January 1991 and December 1998 using 20-gauge (n= 33), 18-gauge (n= 151) or 14-gauge (n= 1) core biopsy needles. A chest radiograph was taken after observation in the Radiology department for 1 h and asymptomatic patients were discharged. RESULTS: The histology was malignant in 150 biopsies (81. 1%) and benign in 23 (12.4%) with 12 false-negative results (6.5%); there were no false-positive results. The sensitivity was 92.6%; specificity 100%; negative predictive value 65.7%; and overall accuracy 93.5%. Pneumothoraces occurred in 48 patients (25.9%); one required aspiration only and four required insertion of an intercostal drain. One patient developed a pneumothorax after discharge. Small haemoptyses occurred in 13 patients without pneumothorax (7.0%), one of whom was admitted. In-patient treatment was required in 10 patients (5.4%). CONCLUSION: Computed tomography-guided cutting needle biopsy of pulmonary lesions is a safe technique with a diagnostic accuracy and complication rate comparable to reported figures for fine needle aspiration biopsy. It can be safely performed on an out-patient basis.     

16层螺旋CT导引下孤立性肺结节穿刺活检

目的:评价并比较16层螺旋CT与单螺旋CT导引下孤立性肺结节穿刺活检的诊断价值及应用的安全性。方法:在16层螺旋CT、单螺旋CT导引下分别对50例肺孤立性结节穿刺活检,对采集的标本行细胞学或病理学检查,术后行CT扫描明确是否有气胸、出血等并发症,分析操作时间、取材准确性及并发症出现率。结果:16层CT穿刺活检组50例中取得满意组织并确诊46例,穿刺平均时间22.8min,并发症出现率8%;单螺旋组50例中取得满意组织并确诊37例,穿刺平均时间35.6min,并发症出现率12%;在不同CT导引下穿刺取材时间及取材准确性比较有统计学意义(P<0.05),并发症出现率无统计学意义(P>0.05)。结论:16层螺旋CT为穿刺定位取材提供了更多信息,16CT定位下的穿刺活检成功率和准确率较高,可作为孤立性肺结节定性诊断的首选方法。     

Image-guided automated needle biopsy of 106 thoracic lesions: a retrospective review of diagnostic accuracy and complication rates

We reviewed the diagnostic accuracy and complication rates of transthoracic needle biopsy (TNB) with an automated 18-gauge core biopsy needle and gun, using either fluoroscopic or CT guidance. One hundred six lesions were biopsied in 103 patients between 1992 and 1998. Hard-copy images, imaging reports, pathology reports and clinical notes were reviewed. In 3 patients it was not possible to establish the lesion as either malignant or benign from the available follow-up, so these were removed from the analysis of diagnostic accuracy. Adequate samples for histological diagnosis were obtained in 104 of 106 (98 %) biopsies. There were 75 of 85 (88 %) true-positive core biopsies for malignant lesions and a specific cell type was identified in 70 of 85 (82 %) cases. A specific histological diagnosis was obtained in 12 of 18 (66 %) biopsies. There was a 19 % rate of pneumothorax with only 2.4 % requiring drainage. Minor haemoptysis occurred in 3.8 % of procedures. The TNB technique with an automated core biopsy needle provides a high level of diagnostic accuracy, effectively distinguishes cell type in malignancy and provides a definite diagnosis in benign disease more frequently than fine needle aspiration (FNA). There is no increased complication rate compared with FNA. Received: 26 January 1999; Revision received: 1 July 1999; Accepted: 2 July 1999     

CT引导下经皮肺穿刺活检对周围型肺部病变的诊断价值

目的探讨CT引导下经皮肺穿刺活检对周围型肺部病变的诊断价值及其安全性。方法对58例周围型肺部病变的患者,在CT引导下行经皮肺穿刺活检。结果 58例患者中穿刺标本经组织病理学检查确诊病例48例,确诊率为82.8%,其中恶性肿瘤32例,良性病变16例。术后出现有症状并发症7例,其中咯血2例,气胸4例,高热伴脓胸1例,总发生率为12.1%。结论 CT引导下经皮肺穿刺活检定位准确,成功率高,安全可靠,在周围型肺部病变诊断中具有较高的应用价值。     

CT定位经皮肺穿刺活检术对周围型肺占位病变诊断的临床应用

目的 探讨CT定位经皮肺穿刺活检术用于肺周围型占位病变诊断的意义。方法 采用美国Cook公司的PREMED716、18、19、20G软组织活检针或不带针芯的细针，长度分别为8、10、12、16cm，外径分别为0．7、0．8、0．9mm，多数选用0．8mm，在PICKER IQXTRACT机导向下穿刺65例肺周围型占位病变。结果 65例经皮肺穿刺活检，经病理检查证实62例，其中原发性恶性肿瘤56例，结核3例，炎性假瘤2例，转移性癌1例，3例未能得到明确诊断，组织学诊断率为95．4％，术后4例并发少量气胸，2例出现血丝痰，均未作特殊处理。结论 CT定位经皮肺穿刺活检是比较安全、准确率很高的诊断手段，且在经济上也是可行的技术，可在有条件的单位广泛应用。     

Transthoracic needle biopsy using a C-arm cone-beam CT system: diagnostic accuracy and safety

Objective

The purpose of this study was to evaluate the diagnostic accuracy and safety of performing transthoracic needle biopsy (TNB) under combined fluoroscopy and CT guidance using a C-arm cone-beam CT (CBCT) system.

Methods

We evaluated the diagnostic accuracy and safety of performing TNB using a C-arm CBCT system. We retrospectively evaluated 99 TNB cases performed in 98 patients using a C-arm CBCT system with an 18-gauge automated cutting needle. We reviewed the diagnostic accuracy according to the size and depth of the lesion, incidence of complications, additional treatment for complications, procedure time, number of needle passes per biopsy and radiation dose.

Results

The final diagnoses revealed 72 malignant and 27 benign lesions. The overall malignancy sensitivity, malignancy specificity and diagnostic accuracy were 95.8%, 100% and 97.0%, respectively, and those for small pulmonary nodules <20 mm in size were 94.1%, 100% and 96.6%, respectively. There was no significant difference in the correct diagnosis of malignancy according to lesion size (p=0.634) or depth (p=0.542). For benign lesions, a specific diagnosis was obtained in 14 cases (51.9%). TNB induced complications in 19 out of 99 procedures (19.2%), including pneumothorax (16.2%), immediate haemoptysis (2.0%) and subcutaneous emphysema (1.0%). Among these, four patients with pneumothorax required chest tube insertion (2.0%) or pig-tail catheter drainage (2.0%). The mean procedure time, number of needle passes and radiation doses were 11.9±4.0 min, 1.2±0.5 times and 170.0±67.2 mGy, respectively.

Conclusion

TNB using a C-arm CBCT system provides high diagnostic accuracy with a low complication rate and a short procedure time, particularly for small pulmonary nodules.Transthoracic needle biopsy (TNB) under image guidance is a well-known procedure for evaluating thoracic mass lesions, with a high diagnostic accuracy and a relatively low complication rate [1-5]. TNB can be performed under various types of image guidance, including fluoroscopy, CT and ultrasonography. The decision regarding which technique to use usually depends on the characteristics of the pulmonary lesions, such as size, location, the radiologist''s preference and the accessibility of imaging systems.Currently, CT or CT fluoroscopy is the most preferred method of image guidance for TNB. CT fluoroscopy provides real-time guidance of the biopsy needle in addition to the advantages of CT guidance, decreasing the procedure time and number of needle passes compared with CT-guided procedures [1]. However, significant radiation exposure to the operator''s hands is one limitation of this procedure.The C-arm cone-beam CT (CBCT) system is a form of flat-panel volume CT in which a cone-beam X-ray tube and a flat-panel detector are integrated within a C-arm gantry. This provides both CT and real-time fluoroscopic guidance for TNB [6].The purpose of this study was to evaluate the diagnostic accuracy and safety of performing TNB under combined fluoroscopy and CT guidance using a C-arm CBCT system.     

CT/fluoroscopy-guided transthoracic needle biopsy: sensitivity and complication rate in 98 procedures

PURPOSE: The purpose of this study was to evaluate CT/fluoroscopy (CTF)-guided core needle biopsies (CNBs) in the thorax. METHOD: Ninety-eight biopsies were performed using a core biopsy needle (18G) with a reusable biopsy gun under CT/F. All results were compared to surgery plus histology or to clinical follow-up of >12 months. Sensitivity, specificity, and negative predictive value (NPV) were calculated. RESULTS: For pulmonary biopsies, sensitivity was 94%, specificity 100%, and NPV 73%; no significant correlation between the pneumothorax rate and the intrathoracic penetration depth was found. For biopsies of the mediastinum and pleura, sensitivities were 87 and 80%, respectively; specificity was 100% in both locations. A pneumothorax occurred in 21%, a pneumothorax requiring drainage in 2.0%. CONCLUSION: CT/F-guided CNB is a reliable method to obtain thoracic biopsies, with a complication rate of 2.0%.     

Nonpulmonary thoracic biopsy

The aim of the present paper is to distinguish between thoracic pulmonary needle biopsy--which can be carried out under fluoroscopic guidance--and thoracic extrapulmonary needle biopsy, which requires a more accurate type of guidance, such as CT. Among the 500 thoracic punctures performed during the last 5 years, we considered only 90 biopsies of mediastinal (N = 58) or thoracic wall (N = 32) masses. We have thus excluded all parenchymal lesions of the lungs. For extrapulmonary thoracic masses, CT was the method of choice for biopsy guidance which provided diagnostic evidence of small-diameter mediastinal lesions that permitted analysis of the relationship to vascular structures and performance of extrapleural needle insertion, using larger-gauge needles to ensure accurate needle placement within the lesion. In both mediastinal and thoracic wall lesions an overall accuracy rate of 84% was obtained. In no case was thoracic drainage required for treatment of the moderate degree of pneumothorax that occurred in 1% of our patient population.     

CT引导下经皮肺穿刺切割活检的价值及安全性

目的：评价CT引导下经皮肺穿刺活检对肺部疑难疾病的诊断价值及安全性。方法：回顾性分析有手术病理、临床或影像随访结果的CT引导下经皮肺穿刺活检105例,其中97例为肺部局限性病灶（A组）,8例肺部弥漫性病灶（B组）。结果：2组共有101例穿刺物结果与手术病理、临床或影像学随访结果相符：穿刺诊断正确率96．2％。A组穿刺诊断正确率（99．0％）高于B组（62．5％）（P〈0．01）。A组肺癌占79．4％（77／97;B组肺癌占60．0％（3／5）;二组差异无统计学意义（P〉0．05）。两组合计发生气胸24例;出血34例,其中咯血18例。结论：cT引导下经皮肺穿刺切割活检穿刺诊断正确率高,是肺内疑难病变定性诊断的理想方法;使用18G穿刺针,可减少穿刺次数、降低出血的发生。