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。     

多层螺旋CT在经皮穿刺肺组织活检中的应用价值

目的探讨多层螺旋CT(MSCT)引导下经皮穿刺肺组织活检的技术方法,并评价MSCT在经皮穿刺肺组织活检中的应用价值。资料与方法对42例患者的42个肺部病灶进行MSCT引导下经皮穿刺肺活检。结果42个病灶均成功穿刺(成功率为100%)。肺外周小病灶的一次穿刺成功率为88.2%(15/17),肺门部病灶的一次穿刺成功率为86.7%(13/15)。病理检出40例,诊断成功率和活检准确率均为95.2%。术后并发肺出血2例,发生率为4.8%;气胸2例,发生率为4.8%。结论MSCT引导不仅能提高经皮穿刺肺外周部小病灶和肺门部病灶的技术成功率、诊断成功率和活检准确性,而且能减少并发症的发生。     

经皮肺穿诊断肺癌的价值

目的　探索模拟机及CT导引经皮肺穿对肺部病灶定性诊断的价值。方法　 32 0例肺部病灶病人 ,模拟定位机导引经皮肺穿 2 90例 ,病灶 1cm× 2cm～ 10cm× 12cm ,周围型 2 6 5例 ;中央型 2 0例 ,两肺弥漫型 5例 ;CT定位经皮肺穿30例 ,病灶 1cm× 1cm～ 3cm× 4cm ;周围型 11例 ;中央型 19例。结果　 30 0例患者确诊为肺癌 ;15例为良性病变。模拟机及CT定位 :癌症确诊率分别为 93.8% (2 72 / 2 90 )和 93.3% (2 8/ 30 ) ;发现早期肺癌分别为 2例和 3例 ;肺部病灶的定性确诊率分别为 98.3% (2 85 / 2 90 )和 10 0 % (30 / 30 ) ;气胸发生率分别为 6 .6 % (19/ 2 90 )和 3.3% (1/ 30 ) ;穿刺后出血发生率分别为 16 6 % (4 8/ 2 90 )和 10 .0 % (3/ 30 )。结论　模拟机及CT导引经皮肺穿安全 ,准确、诊断迅速 ,对肺部病灶的定性诊断有重要意义 ,还可发现早期肺癌。     

US-guided transthoracic cutting biopsy for peripheral thoracic lesions less than 3 cm in diameter

PURPOSE: To evaluate the safety and accuracy of ultrasonography (US)-guided transthoracic cutting biopsy for diagnosing peripheral thoracic lesions (<3 cm). MATERIALS AND METHODS: Fifty consecutive patients with peripheral thoracic lesions less than 3 cm in diameter underwent US-guided percutaneous transthoracic cutting biopsy with a modified technique. Fifty lesions (43 parenchymal lung, two pleural, two chest wall, and three anterior mediastinal lesions) were sampled for biopsy. The final diagnosis was based on histopathologic analysis of surgical specimens (n = 18) or clinical follow-up (n = 32). RESULTS: The histology recovery rate was 98% (49 lesions), and the correct diagnosis was obtained in 48 lesions (96%). Twenty-four (48%) lesions were malignant, and 26 (52%) were benign. The diagnostic accuracy for malignant lesions was 92% (22 of 24 lesions). A specific benign diagnosis was made in 17 (65%) of the 26 benign lesions, and the negative predictive value for malignancy was 93% (26 of 28 lesions). Only two patients (4%) developed postbiopsy pneumothorax, and three (6%) developed postbiopsy hemoptysis. Biopsy helped prevent surgery or thoracoscopy in 32 patients (64%): 18 patients with benign disease and 14 with multiple metastases or inoperable cancer. CONCLUSION: US-guided transthoracic cutting biopsy appears to be a safe and effective method for diagnosing peripheral thoracic lesions less than 3 cm in diameter. The high diagnostic accuracy for benign lesions and metastatic lung cancer can help prevent surgery in many cases.     

超细支气管镜结合经皮肺穿技术在肺外周病变诊断中的价值

目的 评价超细支气管镜结合经皮肺穿技术在肺外周病变诊断中的价值.方法 269例肺外周病变患者均先进行超细支气管镜活检并刷检术,对无阳性结果,且病灶位于肺门、内带或中带的89例患者进行X线引导超细支气管镜肺活检并刷检术;对病灶位于中、外带的77例患者,经X线引导进行经皮肺穿刺针吸活检术;对于超细病灶紧贴胸壁的70例患者经B超引导进行经皮肺自动弹性穿刺切割活检术.结果 269例患者行超细支气管镜肺活检并刷检共276例次,获得诊断者82例,阳性率为30.5%(82/269);89例患者行X线引导超细支气管镜肺活检并刷检94例次,获得诊断者66例,阳性率为74.2%(66/89);77例患者行X线引导经皮肺针吸活检85例次,获得诊断者52例,阳性率为67.5%(52/77);70例患者行B超引导经皮肺自动弹性穿刺切割术79例次,获得诊断者49例,阳性率为70.0%(49/70).4种方法结合后的诊断率(92.6%)明显提高.结论 综合超细支气管镜检查结合经皮肺穿等介入诊断技术,可明显提高肺外周病变的阳性率,值得临床推广应用.     

Percutaneous biopsy of thoracic lesions: value of sonography for needle guidance

Fluoroscopy and CT are widely used to guide percutaneous needle biopsy of thoracic lesions. However, some lesions are not sufficiently visible on fluoroscopy and others are dangerous to access on CT without real-time monitoring. When these are the circumstances, sonographic guidance may be helpful. Real-time sonography was used to guide percutaneous needle biopsy in 124 patients with thoracic lesions. The indications for sonographic guidance included pulmonary, pleural, or mediastinal lesions in contact with the chest wall, including lesions near the heart or great vessels (n = 12); lesions in the apical region (n = 5); lesions in a juxtadiaphragmatic location (n = 6); small lung nodules adjacent to the chest wall (n = 16); and peripheral tumors with adjacent pleural effusion (n = 4). A diagnosis was made in 74 (90%) of 82 malignant lesions and in 24 (67%) of 36 benign lesions. Complications included pneumothorax (n = 5), hemoptysis (n = 1), and hemothorax (n = 1). The advantages of sonographic guidance are that the sonographic equipment is mobile and real-time monitoring makes the procedure safer. Its limitations are that it cannot be used when aerated lung or free air (pneumothorax) lies between the chest wall and the lesion and that cavitary lesions are difficult to sample by biopsy. Our results show that the use of sonographic guidance considerably expands the number of thoracic lesions amenable to percutaneous biopsy.     

超声引导经皮肺穿刺活检在肺外周型病变诊断中的价值

目的探讨超声引导下经皮肺穿刺活检对肺外周型病变定性诊断的应用价值。方法在超声引导下对80例胸部影像学检查显示的肺周边型肿块需明确诊断者行超声引导下经皮肺穿刺活检术。结果 80例病人均穿刺成功,成功率100%。病理诊断结果:恶性肿瘤64例,其中鳞癌38例,腺癌20例,大细胞癌2例,小细胞癌2例,恶性淋巴瘤1例,恶性间皮瘤1例;良性病变16例,其中良性错构瘤1例,结核8例,炎症7例。并发气胸、咯血各1例,并发症发生率为3%。结论超声引导下经皮肺穿刺活检术具有定位准确、操作简便、安全性好、并发症少及重复性强等优点,可作为肺外周型病变定性诊断的首选诊断方法。     

Bronchus sign on CT in peripheral carcinoma of the lung: value in predicting results of transbronchial biopsy

The bronchus sign on CT represents the presence of a bronchus leading directly to a peripheral pulmonary lesion. We investigated the value of this sign in predicting the results of transbronchial biopsy and brushing in 33 consecutive cases of proved peripheral bronchogenic carcinoma studied with thin-slice CT (2-mm-thick sections). The bronchus sign was seen on CT in 22 patients and was absent in 11. Transbronchial biopsy and brushing showed peripheral carcinoma in 13 (59%) of 22 patients in whom the bronchus sign was seen on CT and in only two (18%) of 11 patients in whom it was not seen. The difference is statistically significant (Fisher's exact test, p = .029). When analyzed by the order of involved bronchus, a 90% success rate of transbronchial biopsy and brushing was found in patients in whom the bronchus sign was seen at a fourth-order bronchus (p = .01). This compared with a success of 33% when the bronchus sign was seen at fifth-, sixth-, or seventh-order branches. Our results suggest that the bronchus sign at a fourth-order bronchus is valuable in predicting the success of transbronchial biopsy and brushing. The presence of the sign on CT may be useful in determining if the workup should include transbronchial biopsy and brushing or transthoracic needle aspiration in patients with peripheral lung lesions.     

Myofibroblastic inflammatory tumor of the lung: CT findings with pathologic correlation

The objective of this study was to describe the computed tomographic (CT) features of myofibroblastic inflammatory tumor of the lung with histopathologic correlation. The medical records and imaging studies of eight patients with pathologically proven myofibroblastic inflammatory tumor of the lung were reviewed. On radiographs and CT images, a poorly circumscribed mass or nodule was evident in five patients (six lesions), and a well-circumscribed lesion was evident in three patients (three lesions). Seven lesions were peripheral and two were centrally located. At CT, five lesions were of heterogeneous attenuation and four homogeneous. Increased perilesional parenchymal abnormalities, which were caused by peribronchial inflammatory infiltrates, were observed in three cases. The predominant histopathologic feature was organizing pneumonia type in three cases, lymphoplasmacytic type in three cases, and both organizing pneumonia and lymphoplasmacytic type in two cases. Variable degree of fibrous histiocytoma type was observed in all cases. The imaging characteristics of myofibroblastic inflammatory tumor of the lung are variable and nonspecific. The authors conclude that most cases appear as solitary, peripheral lesions with a predilection for the lower lobes. Associated findings may include perilesional inflammatory changes. Because myofibroblastic inflammatory tumor cannot be reliably differentiated from other pulmonary lesions based solely on the imaging appearance diagnostic biopsy is mandatory. Interpretation of the imaging findings combined with the histopathologic features of disease may help make correct diagnosis.     

Oblique approach of computed tomography guided needle biopsy using multiplanar reconstruction image by multidetector-row CT in lung cancer

The purpose of this study was to establish the technique of multiplanar reconstruction (MPR) with multidetector-row (MDR) computed tomography (CT) guided needle biopsy for the diagnosis to access very difficult lesions. The CT guided percutaneous biopsy are well-established methods to obtain cytological and histological material such as the peripheral tumors in lung cancer. Occasionally, the conventional CT cannot permit planning a trajectory to avoid passage through bones, avoidance of bullae, fissures or vessels. In addition, some lesions are situated in less favorable locations such as those in the costophrenic recess or close to the mediastinum. Rarely can we diagnose them. MPR with MDR-CT has recently become widely available with applications for thoracic lesions. MPR images have been used to evaluate the location of small peripheral lung nodules to the relation of bullaes, vessels, and costophrenic recess. To diagnose these lesions, the usefulness of MPR were evaluated for an planning of an oblique approach of CT guided needle biopsy. MPR images were reconstructed as a line from the needle entry point to the target lesion. The first oblique image applied as the direction of posterior-anterior and cranio-caudal axis, and the second oblique image applied as the direction of posterior-anterior and left-right. Eleven out of 151 patients were required MPR technique to allow possible access to target, because of avoidance of bone and fissures in the needle pass or located in the costophrenic recess, between April 2001 and December 2002. The 5/11 patients were at the upper site (segment 1, 2 and 6) behind the scapula and ribs, 3/11 patients were at the lower lobe (segment 10) in the costophrenic recess, and 3/11 were middle lobe or segment 3 covered by the ribs and fissures. All the lesions except one were histologically diagnosed. Five patients were adenocarcinoma, and the other five patients were benign tumors. Pneumothorax occurred in one patient before we obtained the specimens. MPR guided needle biopsy with oblique approach was thought to be useful for diagnosis of very difficult thoracic lesions and would obviate an unnecessary surgical thoracoscopy.     

CT引导肺穿刺活检诊断周围型肺鳞癌的价值

目的:探讨应用CT引导肺穿刺活检术诊断周围型肺鳞癌的价值。方法:对CT引导肺部病变穿刺活检术的31例病例进行回顾性分析。结果:本组病例中,周围型肺鳞癌CT表现为病灶周边强化伴其内不同程度坏死27例,空洞型病灶4例。CT引导肺部病变穿刺活检病理诊断鳞癌16例,中分化鳞癌14例,发现癌变鳞状上皮1例。结论:研究表明应用CT引导肺穿刺活检术对周围型肺鳞癌病例有重要的诊断价值。     

Computed tomography of folded lung

Computed tomography (CT) scans of 22 examples of folded lung in nine patients were reviewed. The most important CT criteria of folded lung are the presence of vessels and bronchi running in a smooth curvilinear fashion towards a peripheral mass with an ill defined central edge associated with pleural thickening. These features were seen in all 22 examples. The lesions are frequently multiple (eight out of nine patients). When these features are present the diagnosis can be made without recourse to biopsy or thoracotomy. Enhancement with intravenous contrast medium is unnecessary and does not provide any extra useful information. Various other previously described criteria such as air bronchograms are not necessary for the diagnosis.     

Percutaneous needle biopsy of lung nodules following failed bronchoscopic biopsy.

Though transthoracic needle biopsy (TNAB) is a well established method for obtaining pathologic diagnosis in lung masses, very often the procedure is only performed after a previous negative bronchoscopic biopsy (BB) attempt. In this study we analyzed the results of TNAB in 129 consecutive patients where one or more inconclusive BB had been performed. TNAB was diagnostic in 115 of 129 lesions (89%) and the yield was not significantly affected by size, cell type or tumour location. In 97 patients who underwent thoracotomy, cytologic specimens obtained by TNAB accurately reflected histologic tumour type in all cases. A false negative rate for malignancy on TNAB was 5%. Awaiting inconclusive BB results caused an average delay of three in-hospital days before TNAB. In those patients in whom a biopsy is warranted, TNAB is most useful as an initial diagnostic procedure in masses that are peripheral and in pleural based tumours, in mediastinal adenopathy associated with a lung mass and instead of a repeat, previously failed bronchoscopy.     

超声引导周围型肺病变穿刺活检的临床应用

目的:探讨超声引导下周围型肺病变穿刺活检技术及临床应用价值。方法:选用16～18G切割式半自动穿刺活检针,在超声引导下对35例需明确诊断的周围型肺病变患者行超声引导下经皮穿刺活检术。结果:35例患者均穿刺成功,成功率100%;34例确诊,活检确诊率97.1%。结论:超声引导下周围型肺病变穿刺活检具有定位准确、操作简便、安全性好、并发症少及重复性强等优点,为疑难性周围型肺病变明确诊断的首选方法。     

CT-guided needle biopsy of the lung: factors affecting risk of complications

PURPOSE: To analyze factors influencing the risk of complications associated with CT-guided percutaneous needle biopsy for lung lesions. MATERIALS AND METHODS: Sixty patients, aged 24-85 years (37 men and 23 women), underwent CT-guided needle biopsy. A definite diagnosis was made in 49 of 60 cases (81.7%), including 38 of 43 malignant lesions (88.4%) and 11 of 17 benign lesions (64.7%). Complications associated with biopsy were observed in 35 patients (58.3%). Major complications included pneumothorax (n = 26) and pulmonary hemorrhage (n = 20). Chest tube placement was needed in 5 (19.2%) of 26 pneumothorax cases (8.3% of all biopsies). RESULTS: The high frequency of pneumothorax (43.3%) in this series had several contributing factors, including the presence of pulmonary emphysema, lesion size, and traversal of aerated lung. Chest tube replacement was necessary more frequently in patients with pulmonary emphysema. The number of pleural passes, location of lesions, and size of needles were not correlated with the incidence of pneumothorax. CONCLUSION: The presence of pulmonary emphysema, lesion size, and traversal of aerated lung are the predominant risk factors for pneumothorax in patients with CT-guided lung biopsy.     

CT导向经胸穿刺活检108例报告

CT导向经胸穿刺活检108例;纵隔,肺门36例,周围肺野66例,胸膜6例。经手术证实和临床随访,恶性肿瘤的穿刺活检正确率为96％、良性肿瘤为54.5％、非肿瘤性病变为36.4％。4例并发症:2例气胸、2例轻微出血。无空气栓塞及肿瘤扩张。本文讨论了CT导向与电视监视,超声导向的比较,认为CT导向对深部小病灶以及组织结构重叠部位病灶比电视监视、超声导向为好。另外也分析了穿刺针与并发症的关系以及产生并发症的其它因素。并且评价了CT导向穿刺活检在临床诊断的作用。     

DSA Innova CT重建在体表区域定位经皮肺穿刺活检术的应用价值

目的 探讨DSA结合Innova CT重建在体表区域定位经皮肺穿刺活检术的临床应用价值.方法 选取肺占位性病变患者21例,作体表区域定位后行旋转DSA采集,重建Innova CT图像,制订精确穿刺方案,在DSA导向下行经皮肺穿刺活检术.结果 经皮肺穿刺活检取材41次,40牧标本取得组织病理结果,阳性率97.6%,其中1例术中发生气胸,发生率4.8%.结论 DSA结合Innova CT重建引导体表区域定位经皮肺穿刺活检术定位准确,操作简便,安全性高,在诊断肺占位性病变中具有重要的应用价值.     

肺隐球菌病CT征象分析

目的 分析经病理证实的肺隐球菌病(PC)的CT影像表现,加深对本病影像征象的认识及提高诊断水平.方法 回顾性分析经穿刺或手术病理证实的19例PC患者的CT影像及临床资料.结果 ①结节或肿块型10例,结节型多见,直径1~2.5 cm,多发结节易融合.斑片、实变浸润型6例,所见斑片或实变的密度较炎性斑片高,边界多清楚.双肺病灶多为一侧为主,另一侧受累.混合型3例,表现为结节、实变及磨玻璃影等混合存在,均为双肺分布.②病灶分布特点为下肺分布(47%)及胸膜下分布(68%),多为轻~中度强化.③19例患者中,出现影像征象依次为胸膜增厚8例(42%),支气管气相7例(36%),晕轮征5例(26%),空洞4例(21%).结论 PC的CT表现具有多样性.①病灶以下肺及近胸膜分布多见.②病变多为轻~中度强化.③胸膜增厚、支气管气相、晕轮征、空洞等征象对诊断有一定提示意义.     

肺癌的CT诊断(附73例分析)

本文总结病理证实的73例肺癌CT检查所见。50例中央型肺癌CT征象类同平片及体层者但CT评价纵隔淋巴结转移有独到之处。重视支气腔狭窄征及细致的肺门分析是诊断早期中央型肺癌的关键。2例纵隔型肺癌实为周围型鳞癌侵犯纵隔,CT所见优于常规照片。1例周围型腺癌显示成纤维效应、胸膜皱缩,间隔静脉聚集。周围型鳞癌多为分叶状块及短毛刺,1例为巨囊状。肺泡癌CT所见不优于平片。虽然本组总的诊断正确率为98.6％,但CT不能取代针刺活检及经支气管镜活检。     

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。