CT引导下经皮肺穿刺肺小结节的临床价值(附45例报告)

目的探讨肺部直径≤2cm结节灶在CT引导经皮肺穿刺活检的准确性、并发症及诊断价值。方法回顾性分析2005年3月～2008年5月期间行CT引导下经皮肺穿刺活检并经手术病理、临床治疗或随访观察证实且资料完整的孤立性肺结节病例45例,分析其敏感性、特异性、准确性及并发症。结果 45例孤立性小肺结节病灶中经手术病理、临床治疗或随访观察证实为恶性肿瘤者28例,良性病变者17例;而CT引导下经皮肺穿刺活检诊断为恶性肿瘤者22例,良性病变者23例。对恶性肿瘤的诊断敏感性78.6%(22/28),特异性100%(22/22),阳性预测值100%(22/22);对良性病变的诊断特异性100%(17/17),阴性预测值73.9%(17/23);总的诊断准确率86.7%(39/45)。并发症:气胸5例(11.1%),肺出血2例(4.4%),咯血2例(4.4%)。结论直径≤2cm的肺部结节行CT引导下经皮肺穿刺活检的准确率较高而并发症较低,可作为肺内孤立性小结节灶定性诊断的首选方法,值得推广。

Clinical value of percutaneous biopsy of small lung nodules under CT guided(45 cases reported)

Objective To discuss the complications and diagnostic value of the CT guided percutaneous biopsy of lung nodules ≤ 2cm in diameter. Methods 45 patients with solitary pulmonary nodules underwent CT-guided percutaneous lung biopsy between March, 2005 and May, 2008. Results The diagnosis of malignant tumors （28） and benign lesions （17） was confirmed by pathology, treatment or follow-up. The sensitivity of CT-guided percutaneous lung biopsy for malignancy was 76.8% （22/28）, specificity 100% （22/22）, positive predictive value 100% （22/22）, negative predictive value 73.9% （17/23）, and accuracy 86.7% （39/45）. The complications included pneumothorax （5 cases, 11.1%）, pulmonary edema （2 cases, 4.4%） and hemoptysis （2 cases, 4.4%）. Conclusion CT-guided percutaneous biopsy of lung nodules ~〈2cm in diameter has high accuracy and low complication rate. It can be used as a frontline method in diagnosis of solitary pulmonary nodules.