Percutaneous CT‐guided fine‐needle aspiration of pulmonary lesions: Results and complications in 409 patients

The purpose of this study was to report our centre’s experience in the results and complications of percutaneous CT‐guided lung biopsy. A retrospective review of 409 patients who underwent percutaneous CT‐guided fine‐needle aspiration of suspicious lung lesions for more than 5 years was carried out. Nodule sizes ranged from 0.6 to 10 cm. The calibre of the needle used was 21–23 G. Specimen adequacy and patient outcome were evaluated. Each case was reviewed for complications. Sufficient diagnostic material was obtained in 369 (90%) of the 409 fine‐needle aspirations. Diagnosis was malignancy in 290 (70%) samples, four (1%) samples were suspicious for malignancy, 65 (16%) samples were negative for malignancy and definite benign findings were identified in 10 (3%) specimens. There were 25 false‐negative cases and one false‐positive case. Sensitivity was 92% and specificity 98%. Pneumothorax was the most common complication and occurred in 17 (4%) patients. Only one of them required thoracic drainage. Blood effusion around the lesion or along the needle track was detected on the post‐biopsy CT in 8 (2%) patients. However, only one of them suffered from a mild haemoptysis. Percutaneous CT‐guided biopsy is an effective and fast procedure for diagnosis of suspected pulmonary malignancy, with a low complication rate.     

预穿刺在CT引导下经皮肺活检中的价值分析（附35例报告）

目的：探讨CT引导下经皮肺活检术在肺部肿瘤中的诊断价值及预穿刺的作用.方法：回顾性分析从2012年1月到2013年2月经皮肺穿刺活检的35例病人.结果：所有35例均为住院患者,穿刺操作时间平均18.4分钟.穿刺一针成功率91.4％.阳性率94.3％.病理结果：腺癌22例,鳞癌6例,小细胞癌2例,炎性肉芽肿2例,炎性渗出性病变1例,2例未取到阳性结果.出现气胸1例,血胸2例,少量胸水5例,肺内出血3例.结论：CT引导下的经皮肺穿刺活检诊断肺部病变操作简单、阳性率高、并发症少.采用“预穿刺”方法可以进一步增加穿刺的安全性和成功率.     

A severe,late reaction to radiological contrast media mimicking a sepsis syndrome

An unusual, severe delayed reaction to non-ionic intravenous contrast media was observed. A 44-year-old man underwent a computed tomogaphy scan with non-ionic contrast media. Four hours later the patient collapsed with hypotension and cardiovascular shock. Aggressive management (including inotropic support and fluid resuscitation) was instituted in the intensive care unit. Rigorous imaging and biochemical and microbiological investigation failed to identify a source of this man’s circulatory collapse. A rapid recovery ensued and at 3 months follow-up the patient was suffering no residual effects from this event. To our knowledge, this is only the second report of a severe delayed reaction to radiological contrast media and the first that manifested as a prolonged hypotensive syndrome.     

支气管镜下肺活检联合导管吸引细胞学检查对周围型肺癌的诊断价值

目的:评价支气管镜下利用一次性导管吸引细胞学检查联合肺活检收集肺组织标本,观察该方法对在常规支气管镜下不能看到病灶的周围型肺癌患者的诊断价值.方法:回顾性分析2016年10月到2019年10月共138例胸部CT初诊,临床诊断怀疑为肺癌的患者,肺活检联合导管吸引或者单纯肺活检确诊共124例,分析比较两种方法对不同段支气管...     

经皮肺抽吸活检对晚期癌症病人合并肺部疑难病变的诊断价值

目的:探讨经皮肺穿吸活检对晚期癌症患者合并肺实质疑难病变的诊断价值.方法:对51例晚期肺外恶性肿瘤合并肺部实质性病变且诊断有疑难的患者,行经皮肺穿刺抽吸活检术,抽吸物联合进行病理细胞学检查、细菌学培养、抗酸染色检查以明确诊断.结果:51例肺抽吸组织病理学诊断为炎症19例(37.25％)、恶性肿瘤14例(27.45％)、真菌感染8例(15.69％)、结核4例(7.84％)、纤维组织增生3例(5.88％)、无阳性发现3例(5.88％),总阳性率为94.12％ (48/51).病原学检查共检出抗酸染色阳性2例、培养出细菌13例、真菌10例,阳性率分别为3.92％ (2/51)、25.49％(13/51)和19.61％(10/51).结论:经皮肺穿刺抽吸活检术,对抽吸物联合进行病理细胞学、细菌学检查具有较高的检出阳性率,对晚期癌症合并肺部疑难病变患者具有较高的诊断价值.     

液性撤退法联合同轴法减少CT引导下经皮肺穿刺活检气胸并发症

目的:为了降低CT引导下经皮肺穿刺活检的气胸并发症发生率,我们采用了“液性撤退法”.本文初步探讨液性撤退法与同轴法共同应用对于CT引导下经皮肺穿刺活检气胸并发症的减少作用.方法:回顾性分析从2013年1月至2014年12月38例采用同轴法联合液性撤退法进行CT引导下经皮肺穿刺活检的病人,主要研究气胸的发生率.结果:38例肺穿病人中,37例获得明确的病理结果.气胸共发生4例(10.5％),均为轻度气胸,1例操作中发生少量出血(2.6％),6例肺穿后少量痰中带血(15.8％),无感染、针道种植转移或空气栓塞的发生.结论:采用同轴法联合我们首创的液性撤退法,可准确、安全地对肺部病灶进行活检,与单纯应用同轴法比较(气胸发生率30％左右),液性撤退法可显著降低气胸的发生率(10％左右),该方法值得进一步研究和应用.     

CT‐guided percutaneous lung biopsies in patients with haematologic malignancies and undiagnosed pulmonary lesions

We searched the electronic patient database at The University of Texas M. D. Anderson Cancer Center for patients who underwent computed tomography (CT)‐guided needle biopsy between January 2001 and December 2005. Inclusion criteria were a known history of haematologic malignancy and a newly detected, undiagnosed pulmonary lesion on chest CT that required tissue sampling for diagnosis; 213 met these criteria. We analysed the biopsy results for diagnostic yield, factors affecting diagnostic yield and effect on treatment. Of 213 procedures, 191 (89.7%) yielded sufficient material for pathologic analysis; 130 (60%) yielded specific diagnoses, while 61 (28.6%) yielded nonspecific benign diagnoses. Lesions larger than 1 cm, cavitary lesions and lung masses were more likely to yield a specific diagnosis than were lesions smaller than 1 cm, lung nodules and consolidations. The most common specific diagnoses were malignancy (62.8%) and infection (34.3%). The latter was more common in patients with leukaemia, cavitary lung lesions or consolidations, active underlying malignancy, neutropenia, respiratory signs and symptoms and/or fever, bone marrow transplant recipients, and in patients receiving chemotherapy. Lung lesions discovered upon follow‐up imaging in patients who did not have any respiratory signs/symptoms or fever were mostly malignant. Therapeutic changes were more likely after a specific diagnosis than after a nonspecific diagnosis or a nondiagnostic biopsy (88.4% vs. 18.1%; p < 0.0001). CT‐guided lung biopsy has a high diagnostic yield in patients with haematologic malignancies that present with unexplained pulmonary lesions and provides a specific diagnosis in a majority of these patients, leading to therapeutic changes. Copyright © 2009 John Wiley & Sons, Ltd.     

Fine-needle aspiration biopsy versus core-needle biopsy in diagnosing lung cancer: a systematic review

Background

Lung cancer leads cancer-related mortality in the world. The objective of the present systematic review was to compare fine-needle aspiration biopsy (fnab) with core-needle biopsy (cnb) for diagnostic characteristics and yields for diagnosing lung cancer in patients with lung lesions.

Methods

The medline and embase databases (from January 1, 1990, to September 14, 2009), the Cochrane Library (to Issue 4, 2009), and selected guideline Web sites were searched for relevant articles.

Results

For overall diagnostic characteristics (benign vs. malignant) of fnab and cnb, the ranges of sensitivity were 81.3%–90.8% and 85.7–97.4% respectively; of specificity, 75.4%–100.0% and 88.6%–100.0%; and of accuracy, 79.7%–91.8% and 89.0%–96.9%. For specific diagnostic characteristics of fnab and cnb (identifying the histologic subtype of malignancies or the specific benign diagnoses), the ranges of sensitivity were 56.3%–86.5% and 56.5–88.7% respectively; of specificity, 6.7%–57.1% and 52.4%–100.0%; and of accuracy, 40.4%–81.2% and 66.7%–93.2%. Compared with fnab, cnb did not result in a higher complication rate (pneumothorax or hemoptysis). No study has yet compared the diagnostic yields of fnab and of cnb for molecular predictive-marker studies in patients with lung lesions.

Discussion and Conclusions

The evidence is currently insufficient to support a difference between fnab and cnb in identifying lung malignancies in patients with lung lesions. Compared with fnab, cnb might have a higher specificity to diagnose specific benign lesions. Well-designed, good-quality studies comparing fnab with cnb for diagnostic characteristics and yields in diagnosing lung cancer should be encouraged.     

Percutaneous transthoracic CT guided biopsies of lung lesions; fine needle aspiration biopsy versus core biopsy

Background

The purpose of this retrospective study was to compare the results and complication rate in CT guided percutaneous trans-thoracic fine needle aspiration biopsies (FNAB) and core biopsies of lung lesions, and to determine the applicability of these needles.

Patients and methods

In 242 patients (166 males; 76 females) with mean age of 58.9 years (13–84 years) CT guided biopsies of lung lesions were performed on dual slice CT equipment. The average diameter of lung lesion was 2.9 cm (1.2–6.3 cm). For FNAB’s 20 – 22 G Chiba needles and for core biopsies 14 G biopsy needles were used. The samples were sent for the histological analysis. The cytological or histological results and the eventual complications were compared.

Results

FNAB’s cytological samples were adequate for definitive diagnosis in 117 patients (79.60 %) and inadequate in 30 patients (20.40 %). Core biopsies samples were adequate in 92 (96.85 %) patients and non- representative (necrotic tissue) in 3 (3.15 %). Pneumothorax as the most frequent complication was detected in 14 (9.7 %) of the patients in the group of FNAB’s and in 30 (31.5 %) of the patients with the core biopsy group.

Conclusions

The results showed that percutaneous transthoracic CT guided biopsies of lung lesions were an effective and safe procedure in the diagnosis of lung lesions. Core biopsy gives a higher percentage of representative samples than FNAB, and is a preferred method regardless of the higher rate of complications.     

全自动与半自动活检针在CT引导经皮肺穿刺活检中的临床应用#br#

目的比较全自动式和半自动式两种活检针在CT引导下肺穿刺活检术的临床应用。 方法回顾2015年3月至2016年10月于本院进行CT引导下经皮肺穿刺活检术患者242例,其中157例使用全自动活检针（全自动组）,余85例使用半自动活检针（半自动组）,比较两组的穿刺成功率、充足标本率、诊断效能（准确率、敏感性和特异性）及常见并发症的发生率。 结果两组的穿刺成功率均为1000％,全自动组的充足标本率为1000％（157／157）,高于半自动组的953％（81／85）,差异有统计学意义（P＜005）;全自动组的特异度和准确率分别为917％（22／24）和981％（154／157）,均高于半自动组的700％（7／10）和准确率为926％（74／81）,差异有统计学意义（P＜005）,但全自动组和半自动组的敏感度为992％（132／133）和944％（67／71）,差异无统计学意义（P＞005）。全自动组针道出血的发生率为338％,高于半自动组的212％（P＜005）,两组气胸、血胸、痰中带血、穿刺相关感染、空气栓塞和和胸膜反应发生率的差异无统计学意义（P＞005）。 结论CT引导经皮肺肿物穿刺活检术操作中,两种活检针各有优缺点,仅适用范围不同,全自动活检针充足标本率、诊断准确率和特异性更高,并发症可控,半自动活检针针道出血风险小。     

Corticosteroid prophylaxis for patients receiving intravascular contrast agents: A survey of current practice in Australia and New Zealand

A survey was made of the use of corticosteroid prophylaxis in patients receiving intravascular contrast media. The replies of 807 respondents were available for analysis and they indicate that such a strategy is common for‘high-risk’patients (62.4%), but very few respondents use corticosteroid prophylaxis for all patients (0.74%).     

CT引导肺穿刺对肺内〈3cm病灶的活检价值

目的评价CT引导肺穿刺对肺内〈3cm病灶的活检价值。方法回顾性分析CT引导下肺部病变穿刺活检213例,均有手术病理和临床随访资料证实。按病灶大小分为两组,其中≥3cm者136例,为大病灶组;〈3cm者77例,为小病灶组。比较两组病例的诊断准确率及并发症发生率。结果CT引导肺穿刺活检对大病灶组、小病灶组的诊断准确率分别为83．09％和84．42％,P〉0．05。气胸发生率为3．68％和15．58％,出血发生率为6．62％和24．68％,P均〈0．05,小病灶组气胸及出血发生率高于大病灶组。结论CT引导肺穿刺活检对于肺内〈3cm病灶的诊断准确率与≥3cm的病灶组相近;小病灶组的并发症发生率高于大病灶组,但无严重并发症,安全性较好。     

立体定位针吸活检与导丝导向切除活检对隐匿性乳腺病变诊断价值的比较

临床触诊阴性而乳腺摄片或者高频超声探头探测的微小病灶分别用钼靶X线或B超立体定位下穿刺活检病理检查 ,随后将头端带有倒勾的钢丝头端置于病灶中心 ,指导手术切除病理检查。结果示 5 1例患者 ,穿刺活检检出 2 3例恶性病变 ,良性病变 2 8例 ;此 2 8例良性肿瘤 ,其中 4例在导丝导向活检中诊断恶性疾病 ,针吸活检乳腺癌的诊断符合率 92 2 % ( 4 7/ 5 1) ,假阴性率 7 8% ( 4 / 5 1)。初步研究结果提示 ,X线或B超下乳腺病灶穿刺活检及钢丝导向手术切除病灶活检均具有定位准确、创伤小 ,是诊治隐匿性乳腺疾病的可靠方法。但针吸活检有一定的漏诊率     

Hypercalcemia-Leukocytosis syndrome and adenosquamous lung carcinoma: An overlooked conjugation

Hypercalcaemia and leukocytosis are two paraneoplastic conditions associated with poor prognosis. Adenosquamous carcinoma is a rare and aggressive histological subtype of lung cancer consisting of adenocarcinoma and squamous cell components. We report the case of a 57-year-old male smoker who was admitted to the Emergency Room with skull and neck tumefactions, confusion and deteriorated general condition. The complementary study in the ER revealed severe hypercalcaemia (19.8 mg/dL), leukocytosis (18.7 × 10⁹ /L) and extensive osteolytic lesions of the skull on cranioencephalic computer tomography (CT). The patient was stabilized and admitted. Thoracoabdominopelvic CT showed lung parenchyma consolidation with necrotic areas, supra and infradiaphragmatic adenopathies and scattered osteolytic lesions. Percutaneous lymph node biopsy was consistent with metastasis of adenosquamous lung carcinoma. The patients’ clinical situation evolved unfavourably after hospital-acquired infection. This case is characterized by a rare presentation of advanced stage adenosquamous lung carcinoma with scattered osteolytic lesions and severe hypercalcaemia-leukocytosis syndrome, an underrecognized marker of poor prognosis.     

彩色多普勒超声介导周围型肺占位穿刺活检的临床应用

目的 观察彩色多普勒超声介导下穿刺活检对肺周围型占位性病变的安全性及诊断准确性,探讨该方法在临床中的应用价值。方法 在彩色多普勒超声引导下,应用自动活检装置对97例经CT检查显示为周围型肺占位病变患者进行穿刺活检。结果 取材成功率98.9%;93例获得正确诊断,组织病理学符合率95.9%;恶性71例,良性25例,其中假阴性3例,假阴性率4.1%(3/74);1例因取材量不足而无法做出病理诊断。结论 彩超介导下周围型肺占位病变的穿刺活检具有操作简便,成功率高,安全性好等优点,值得临床推广应用。