CT导向下腹部肿块细针穿刺抽吸活检

Fine needle aspiration biopsy were made under CT guidance of 50 cases of intra-abdominal masses, including liver in 37 cases, kidney in 6, pancreas and spleen in 1 respectively, and 5 biopsies were made of tumors of the abdominal cavity. The overall diagnostic accuracy was 92%, and the accuracy for malignancies was 84.6%. No complications occurred related to the procedure. The relevant factors for precise biopsy safety and the therapeutic value of this technique were discussed. It was concluded that CT-guided fine needle aspiration biopsy is precise in localization, it is a safe approach yielding satisfactory diagnostic accuracy.     

Mediastinal needle biopsy

A review of 52 consecutive needle biopsies of the mediastinum is presented. The aspirated material yielded cytologic and/or histologic diagnosis in 50 needle biopsies; two needle biopsies failed to yield adequate cellular material for diagnosis. All but two of the 50 patients had confirmation of the biopsy diagnosis by surgical, autopsy, or clinical correlation. In 32 patients, a 20-gauge needle was used for the biopsy. A larger-bore (17-gauge) needle with a cutting device was used in 20 cases to obtain more tissue for histologic diagnosis of benign or unusual malignant lesions. Despite the larger size of the needle, the rate of complications remained low.     

CT-guided transthoracic needle biopsy

CT-guided biopsy of pulmonary and mediastinal lesions is safe and effective. It is most valuable in those cases in which fluoroscopic guidance is not possible due to resolution or anatomic consideration. CT guidance permits puncture of lesions as small as 0.5 cm, typically not seen fluoroscopically. Sensitivity of biopsy in malignant lung lesions in our series of 83 cases was 92%. Pneumothorax is the most frequent complication (10–60%) and requires chest tube insertion in 5–15% of patients.     

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.     

胸部结节或肿块的 CT 导向穿刺活检的临床应用

目的：探讨CT导向下经皮穿刺活检对胸部结节或肿块病变诊断的临床意义。方法 CT导向下采用18~20 G切吸两用穿刺针对25例胸部占位性病变进行穿刺并活检。结果25例患者穿刺活检病理诊断为恶性肿瘤12例,良性肿瘤4例,结核3例,淋巴结肿大6例;恶性肿瘤中鳞癌6例,腺癌2例,小细胞癌1例,转移瘤3例。总阳性诊断率达100%,其中细胞学诊断阳性率76%,组织学诊断阳性率92%。无一例发生严重并发症及针道转移。结论 CT导向穿刺对胸部结节或肿块的诊断安全有效,值得临床广泛应用。     

CT引导经皮肺穿刺活检术对肺门肿块的诊断价值

目的 研究CT引导经皮肺穿刺活检术对肺门肿块的诊断价值.方法 76例纤维支气管镜检查失败或没有明确病理结果的肺门肿块患者行CT引导经皮肺穿刺活检术.结果活检阳性率为100％.结果 获鳞癌32例,小细胞癌13例,腺癌27例,大细胞癌3例,淋巴瘤1例.其中58例行EGFR突变位点检测,突变率为46.6％(27/58).结论 CT引导经皮肺穿刺活检术对肺门肿块诊断阳性率高,可提供可靠的病理诊断指导临床治疗.     

CT导向下纵隔肿瘤穿刺活检术

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。芽刺针采用18G CHIBA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；②63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；③11例病理诊断不确定：临床诊断为恶性淋巴瘤1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：CT导向下纵隔肿瘤穿刺活检术是纵隔病变安全而有效的诊断方法。     

Hilar masses: evaluation with CT-guided biopsy after negative bronchoscopic examination

Computed tomography (CT)-guided biopsies of 20 patients with hilar masses were performed after non-diagnostic bronchoscopic examination. Bronchoscopy included washings, brushings, routine biopsy, and, in many cases, transbronchial biopsy. In all but one case (95%), biopsy with a 22-gauge needle permitted a cytologic diagnosis of malignancy. In 14 of the 19 cases (74%), a diagnosis of primary lung carcinoma involving the hili was made, and in the remaining five of the 19 (26%), metastatic hilar adenopathy from an extrathoracic primary tumor was identified. A pneumothorax rate consistent with our average rate for CT-guided biopsies (25%) was obtained, and only one patient required chest tube placement. In this series, CT-guided biopsies of hilar masses were more consistently successful in obtaining tissue for diagnosis than were bronchoscopic biopsies. Transthoracic needle aspiration biopsy may be the preferred initial diagnostic procedure in many patients with hilar masses.     

Diagnostic value of CT-guided biopsy of indeterminate renal masses

AIM: To evaluate the role of percutaneous core biopsies in the diagnosis of renal masses that could not be classified as benign or malignant based upon imaging alone. MATERIALS AND METHODS: We retrospectively analysed core biopsies of indeterminate renal masses of 23 patients who were referred to us for computed tomography (CT)-guided biopsy from 1996-2001. Follow-up ranged from 1-5 years. Analysis was based on indications for biopsy, size and characteristics of the lesion and accuracy of biopsy results. RESULTS: There was one technical failure in 22 patients included in the analysis. Fifteen core biopsies revealed malignancies that were confirmed either clinically or surgically. Seven were benign, one of which was false-negative. The sensitivity was 93%, specificity 100%, positive predictive value 100% and negative predictive value 75%. The results in tumours <==3 cm were similar to those in larger lesions. CONCLUSIONS: We recommend the use of core biopsy as a diagnostic tool for indeterminate renal masses, regardless of mass size. Renal core biopsy can influence the management of lesions: primary renal lesions are resected, while treatment for metastatic disease is tailored to the primary tumour. Tumours with benign biopsy results should be re-evaluated and either referred for resection of the mass or followed up closely with clinical observation and of imaging studies.     

CT-guided transthoracic needle biopsy of pulmonary lesions: comparison between the cutting needle and aspiration needle

Objectives:To compare CT-guided transthoracic cutting needle biopsy (TCNB) with transthoracic aspiration needle biopsy (TANB) for pulmonary lesions with respect to the diagnostic accuracy and complication rate.Methods:Of the 859 cases that underwent consecutive CT-guided biopsy of pulmonary lesions, 713 cases confirmed by surgical pathology or clinical follow-up were enrolled. Of these, the first consecutive 275 cases underwent TANB, and the remaining 438 received TCNB. The final diagnosis determined the accuracy of biopsy. Based on the post-biopsy CT and clinical medical records, the presence or absence of biopsy-related complications was determined. The χ² test was used to compare the differences between TCNB and TANB in terms of diagnostic accuracy and complication rate.Results:Among the 713 biopsy lesions, the final diagnosis was malignant in 411 cases and benign in 302 cases. As compared to TANB, the diagnostic accuracy of TCNB (98.9% vs 93.8%, χ² = 14.35, p < 0.01), sensitivity to malignant lesions (97.8% vs 90.6%, χ² = 10.58, p < 0.01), negative predictive value (97.6% vs 84.8%, χ² = 19.03, p < 0.01), and specific diagnostic rate for benign lesions (73.4% vs 57.9%, χ² = 7.29, p < 0.01) were improved. On the other hand, a statistical difference was detected between TCNB and TANB with respect to the incidence of pneumothorax (20.6% vs 13.1%, χ² = 6.46, p = 0.01), hemorrhage (32.2% vs 13.1%, χ² = 33.03, p < 0.01), and hemoptysis (8.2% vs 3.3%, χ² = 6.87, p < 0.01). One patient died just several minutes after TCNB due to severe hemorrhage with hemoptysis.Conclusions:Compared to TANB, CT-guided TCNB improves the diagnostic accuracy of pulmonary lesions, but complication rate increases significantly.Advances in knowledge:In general, TCNB should be recommended, especially for highly suspicious benign lesions. For patients with small lesions adjacent to vessels or vessels within the lesion, TANB should be considered.     

CT-guided transthoracic needle biopsy using an ipsilateral dependent position

OBJECTIVE: We postulated that the pneumothorax rate of transthoracic needle biopsy might improve with an ipsilateral dependent position of the affected side. We tried to determine the feasibility, effectiveness, and safety of CT-guided biopsy with the patient in this position. SUBJECTS AND METHODS: CT-guided needle biopsy with the patient in an ipsilateral dependent position was performed in 23 patients with 17 lung lesions (15 posterior and two anterior) and six mediastinal lesions. Fine-needle aspiration was used in all patients, and core biopsy was also used in six patients. The technical difficulty of the procedure was classified into three grades compared with a routine transthoracic needle biopsy as follows: grade I, no more difficult; grade II, somewhat more difficult; and grade III, much more difficult. RESULTS: Adequate samples were obtained in 22 (96%) of 23 patients. A small asymptomatic pneumothorax occurred in two patients (8.7%). Difficulty was rated grades I, II, and III in 18 (78%), two (9%), and three (13%) procedures, respectively. Four of the five grades II and III procedures were biopsies of anterior lesions. Traversing the pleura was avoided in three of six mediastinal masses. CONCLUSION: Transthoracic needle biopsy of selected lung and mediastinal lesions using an ipsilateral dependent position is feasible, effective, and safe. The role of this technique for reducing the rate of pneumothorax as a result of the biopsy requires further investigation.     

CT-guided aspiration core needle biopsy of gastrointestinal wall lesions

PURPOSE: The purpose of this work was to examine the accuracy and safety of CT-guided core biopsy of gastrointestinal wall lesions. METHOD: We reviewed over 1,200 CT-guided abdominal core biopsy results from 1989 through 1998. Forty-five were from gastrointestinal wall lesions (16 gastric, 3 duodenal, 7 small intestine, and 19 colon). RESULTS: A definitive histologic diagnosis was obtained from the core biopsy in 41 patients (91%) without complication. The gastric lesion diagnoses were mesenchymal tumor of smooth muscle origin (eight), lymphoma (one), adenocarcinoma (three), and normal (one). Duodenal core biopsy diagnoses were inflammation (one) and normal (one). Small intestinal core biopsy diagnoses were non-Hodgkin lymphoma (four), metastatic leiomyosarcoma (one), carcinoma (one), and tuberculosis (one). Colon core biopsy diagnoses were carcinoma (11), lymphoma (2), actinomycosis (2), granulomatous inflammation (1), metastatic squamous cell carcinoma (1), chronic abscess (1), and mesenchymal tumor of smooth muscle origin (1). CONCLUSION: Percutaneous CT-guided core needle biopsy from gastrointestinal wall lesions is safe and accurate, especially in submucosal lesions, and should be considered in selected cases with negative endoscopic biopsy or in which endoscopic biopsy is not possible.     

Percutaneous CT-guided multisampling core needle biopsy of thoracic lesions

OBJECTIVE: The purpose of our study was to evaluate the diagnostic yield and the complication rate of percutaneous CT-guided coaxial 18-gauge (1.25-mm diameter) multisampling (five samples) core needle biopsy (CNB) of suspected thoracic lesions. MATERIALS AND METHODS: The records of 75 consecutive patients (29 women, 46 men; age range, 33-92 years) who underwent percutaneous CT-guided adjustable coaxial 18-gauge multisampling (five samples) CNB of a suspected thoracic lesion (eight mediastinal lesions, two chest wall lesions, two pleural lesions, and 63 intrapulmonary lesions) were reviewed. RESULTS: Ninety-seven percent (73/75) of CNB specimens were considered adequate for a specific diagnosis by the histopathology staff. Diagnostic yield was 97% (95% confidence interval, 91-99%) (72/74) (number of correct diagnoses obtained at CNB / number of definitive diagnoses). There were 61 malignant lesions and 11 benign lesions. There was no false-negative result when CNB was considered adequate for a specific diagnosis by the histopathology staff. Pneumothorax occurred in 19% (12/63 intrapulmonary lesions). One patient required placement of a chest tube. Minor postbiopsy hemoptysis occurred and resolved spontaneously in 11% (7/63) of patients. CONCLUSION: Percutaneous CT-guided coaxial multisampling large CNB of suspected thoracic lesions, in a mainly cancer-based population, is an accurate procedure for a specific histologic diagnosis and has a low rate of complications.