优化CT引导下穿刺活检技术在肺部亚厘米结节中的应用

目的通过优化的CT引导下穿刺活检技术联合17G同轴套管活检枪与传统的18G切割活检针旋转切割抽吸肺部亚厘米结节(sub-centimeter pulmonary nodules, sPN)方法及结果进行对比,探讨前者的应用技巧及两者在sPN穿刺中的阳性率、准确率、手术耗时及出血并发症等方面的差异。方法试验组:78例在CT引导下应用17G同轴套管活检枪联合优化的穿刺活检技术取得病理标本并获得病理结果。对照组:54例应用18G穿刺活检切割针及旋转切割负压抽吸穿刺活检技术并获得病理结果。计量资料采用t检验,计数资料采用χ~2检验。结果试验组中41例良性, 34例恶性,3例阴性。对照组16例为良性,22例恶性,无取得明确病理结果者16例。试验组平均完成时间(18.03±8.08) min较对照组(22.31±7.55)min缩短,试验组阳性率(96.15%)高于与对照组(70.37%),试验组出血发生率(26.92%)低于与对照组(35.18%),差异均有统计学意义(P=0.041,0.000,0.045)。结论应用优化的CT引导下穿刺活检技术联合同轴套管活检枪不但可以提高活检的阳性率及准确率,活检时间明显缩短,出血并发症明显减少。     

CT引导下活检枪切割针肺活检的操作技术分析

目的探讨CT引导下活检枪切割针肺活检的操作技术要领和应用价值。资料与方法应用Bard Magnum Biopsy System活检枪及配套活检针，对72例肺部疾病患者行CT引导下肺活检。观察进针成功率、阳性诊断率、确诊率、并发症等，总结穿刺操作技术细节要领。结果一次进针成功率65％，阳性诊断率97％，确诊率89％，无须治疗的轻微并发症65％。平静呼吸下定位和穿刺、“优先4角度”定向、“三点一线”麻醉技巧、“三段进针”和“两快一慢”穿刺技巧是穿刺成功的重要操作技术要领。结论熟练掌握操作技巧，CT引导下活检枪切割针肺活检安全有效、简便易行、具有较大的临床实用价值。     

肺深部病变穿刺活检中两种不同活检枪的比较研究

目的 研究同轴套管型自动活检枪在肺深部病变穿刺活检中的应用价值.方法 144例肺深部病变穿刺病例,根据所用器械不同分为两组,其中A组83例采用同轴套管型自动活检枪,B组61例采用普通自动活检枪.统计每组的活检阳性率、诊断准确率、气胸发生率及针道出血发生率,对两组数据进行比较分析.结果 两组比较在活检阳性率及诊断准确率上无显著性差异,在气胸及针道出血的发生率上A组较B组明显降低,两组比较差异有统计学意义(P<0.05).结论 在肺深部病变的穿刺活检中,采用同轴套管型自动活检枪不影响活检阳性率及诊断准确率,且较之采用普通自动活检枪更安全、更方便,值得临床推广.     

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.     

同轴穿刺技术在肺内孤立性小结节活检中的临床应用

目的 探讨在CT引导下,应用同轴技术经皮穿刺肺内孤立性小结节的可行性、操作技巧及应用价值.方法 34例肺内孤立性小结节患者,在CT引导下应用同轴技术行穿刺活检术,取出组织经固定后行组织病理学检查,分析穿刺成功率、诊断符合率及并发症的发生率.结果 34例患者,均穿刺成功,取得标本多少不一,组织学除1例腺癌误诊为慢性炎症外,其余均作出正确诊断,穿刺成功率为100％,诊断符合率为97.05％.10例出现气胸,12例伴有出血,其中2例为气胸合并出血,气胸总发生率为29.4％,出血总发生率为35.3％.结论 应用同轴技术穿刺肺内小结节,可多方向多次取材,获得较满意的组织量,从而提高阳性率及诊断率,具有较高的临床应用价值.     

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。     

肺内结节灶的CT引导穿刺活检

肺内定性困难的病灶,行CT引导下穿刺活检已应用广泛.但对肺内小结节病灶的CT引导穿刺报道较少,而对穿刺不同部位病灶其气胸发生率不同的报道更少.本文总结了51例肺内结节灶的CT引导穿刺活检的资料,旨在探讨其应用价值与最佳适应证.     

CT引导下骨穿刺活检

目的:探讨CT引导下活检在骨骼病变中的临床应用价值.材料和方法:对70例患者在CT引导下行骨穿刺活检,采用Akerman骨钻针、Qc弹道式活检枪和Chib针.结果:穿刺准确率100%,活检诊断总正确率90%,未出现严重并发症.结论:CT引导下骨穿刺活检是一种安全、准确和有效的方法,可为临床治疗提供必要的依据.根据病变类型选用不同活检针以及有关科室配合,可提高活检成功率.     

多层螺旋CT引导BARD活检枪经皮肺穿刺活检的临床应用

目的 探讨多层螺旋CT(MSCT)导向下,用BARD活检枪细针同轴多点多向经皮肺穿刺活检的临床应用价值.方法 MSCT引导下用BARD MAGNUM自动活检枪,对68例患者行肺穿刺活检.结果 68例患者穿刺成功率100%.以手术病理或临床随访结果 为标准,定性诊断的准确率为94.1%(64例),其中鳞癌30例,腺癌21例,转移瘤7例,炎性假瘤3例,肺脓肿2例,结核1例.假阴性率为5.9%,并发症的发生率为8.8%(6例).结论 采用MSCT引导,结合BARD活检枪同轴法多点多向肺穿活检,具有定位准确、安全可靠、穿刺成功率诊断准确率高、并发症少等优点.     

改良的CT引导下同轴法经皮肺穿刺活检术应用

目的：探讨CT引导下同轴法经皮肺穿刺活检术的临床应用价值。方法：选择因肺内病变需活检的116例患者,所有患者均采用CT引导下自动活检枪同轴法经皮肺穿刺活检术。结果：116例患者均成功获取病理标本,穿刺成功率100％,病变阳性率94．8％,并发症6例（5．2％）,经对症处理后2～7天后患者身体逐渐恢复。结论：改良CT引导下经皮肺穿刺活检术器材简单易得,费用低廉操作简便,穿刺成功率高、并发症发生率低。     

Postmortem evaluation of four randomly selected automated biopsy devices for transthoracic lung biopsy

Purpose To evaluate four automated devices to achieve transthoracic lung biopsy.Methods Transthoracic lung biopsy specimens were obtained randomly from 21 human cadavers with unsuspicious lungs using Biopty (18- and 20-gauge), BIP (18 and 20-gauge), ASAP (18 gauge), and Autovac (18- and 20-gauge) devices. A total of 63 biopsies were carried out with each device and each needle diameter. The same devices and needles were then used randomly for biopsy of peripheral lung metastases. Specimens obtained during both parts of the study were analyzed for the area of tissue on the histologic section, adequacy of tissue for diagnosis, tissue preservation, and crush artifact. The examining pathologist was kept unaware of which procedure was used to obtain the specimens and the cadavers' clinical history.Results The Biopty 18-gauge device performed statistically better than any other of the evaluated systems for biopsy of normal lung parenchyma (p < 0.05). For biopsy of lung metastases, the differences between the devices and needle diameters were less, although the Biopty 18-gauge device performed better than the Autovac 18-gauge, BIP 18-gauge, and all 20-gauge devices for the area of tissue on the histologic section (p < 0.05). The results of the full-cut Autovac biopsy system were remarkable because of the large number of biopsies during which no tissue was obtained.Conclusion Automated biopsy devices can obtain high quality lung specimens sufficient for definite histopathologic diagnosis. However, additional clinical studies on the use of automated biopsy devices for lung biopsy are mandatory.     

Percutaneous biopsy of pancreatic lesions

Percutaneous biopsy provides an effective means of tissue diagnosis in pancreatic lesions. Accuracy rates are ranging between 72 and 100%, with a sensitivity for carcinomas between 69 and 90% and a constantly high specificity of 100% in most series of the literature. The rate of major complications is low, with an incidence of about 0.05%.     

Percutaneous biopsy of the liver

Retrospective evaluation of 510 percutaneous CT-guided biopsies of the liver mainly fineneedle aspiration biopsies for cytology (89% of cases), yielded an overall accuracy rate of 92% and a sensitivity of 94%. The relatively high percentage of false-positive diagnoses (7% of all benign tumors) may be reduced by more consistent consideration of possible errors in cytology and a more consistent use of large bore biopsies.     

Image-guided musculoskeletal biopsy

Image guidance allows safe passage of needles, often into small and otherwise inaccessible lesions, and into the portions of the lesion most likely to yield useful samples, while avoiding damage to important structures. This article hopes to provide a useful guide to image-guided musculoskeletal biopsy for radiologists in practice and in training.     

Percutaneous biopsy of the kidney and adrenal glands

Percutaneous biopsy techniques play an important role in the diagnosis and management of patients with known or suspected malignancies. With refinements in biopsy techniques and the use of sophisticated guiding modalities, tissue can be reliably obtained for either cytologic or histologic evaluation. These procedures are safer and more cost effective than the surgical option of open biopsy.     

Fine needle biopsy without syringe aspiration

Aspiration biopsies of fresh disease-free bovine hepatic liver were performed with three commercially available, small-gauge biopsy needles. A syringe was used to create a negative pressure when using Chiba^® and Sure-cut^® needles. A syringe was not used when using PercuCut^TM needles which create an internal negative pressure equivalent to a 1.5 ml syringe when the stylet is partially withdrawn. The PercuCut and Chiba needle yielded a significantly larger specimen size than the Sure-Cut needle. There was no significant difference in sample size between the PercuCut and Chiba needles. All samples were of diagnostic quality.     

CT-guided biopsy of pelvic masses

CT-guided fine-needle puncture (FNP) was carried out in 74 patients with pelvic masses and resulted in a correct diagnosis in 36/45 patients (80%) with malignant disease. FNP was true-positive in 66.7% and false-negative in 20%. In benign and inflammatory pelvic space-occupying lesions, FNP confirmed the suspected CT diagnosis in all cases by cytology and bacteriology. CT-guided puncture should always be used complementary to CT when a mass of unclear etiology is present.     

经会阴前列腺分层饱和穿刺活检在首次前列腺穿刺活检阴性患者中的价值

目的 探讨经会阴前列腺分层饱和穿刺活检在首次前列腺穿刺活检阴性患者中的应用价值。方法84例因直肠指诊、血清前列腺特异性抗原（PSA）和前列腺MRI检查异常而接受经直肠标准12针穿刺活检且结果为良性的患者,行超声引导下经会阴前列腺分层饱和穿刺活检,计算前列腺癌的检出率。结果84例患者行经会阴前列腺分层饱和穿刺活检,诊断为前列腺癌23例（27.4%）,良性前列腺增生61例（72.6%）,其中合并高级别上皮内瘤变3例,慢性前列腺炎5例。结论经会阴前列腺分层饱和穿刺活检可以提高前列腺癌的检出率,对于初次活检阴性,但直肠指诊、前列腺MRI检查异常并且血清前列腺特异性抗原持续升高的患者,可以考虑应用此穿刺活检方法再次穿刺活检予以明确诊断,避免漏诊和延误治疗。     

Factors predicting successful needle-localized breast biopsy

RATIONALE AND OBJECTIVES: The purpose of this study was to identify factors that predict successful removal of nonpalpable breast lesions with mammography-guided needle-localized breast biopsy. MATERIALS AND METHODS: Of the 455 consecutive patients referred for needle-localized breast biopsy of one or more nonpalpable breast lesions between January 1990 and December 1994, 272 (59.8%) had sufficiently complete data to be included in this study. Medical charts, pathology laboratory reports, wire-placement mammograms, and radiographs of specimens from each patient were retrospectively reviewed to evaluate the effect of the following factors on the success of the procedure: distance from the lesion to the localizing wire, breast density, breast size, specimen volume, and lesion volume. All radiographs were independently evaluated by two radiologists who are experts in breast imaging. RESULTS: Needle-localized breast biopsy was successful in 254 (93.3%) of 272 lesions. Placement of the localization wire within 5 mm of the breast lesion was a significant predictor of successful lesion removal (P = .007). Results from logistic regression analysis showed that needle-localized breast biopsy failure was associated with increased wire distance (P = .0006), decreased breast size (P = .02), and decreased specimen volume (P = .03). CONCLUSION: Needle localization wires should be placed within 5 mm of mammographically visible lesions to increase the probability of successful lesion excision.