CT引导下经皮穿刺活检对周围孤立性肺磨玻璃结节的诊断价值

目的 探讨CT引导下经皮穿刺活检对周围孤立性肺磨玻璃结节（GGO）的诊断价值。 方法 选取2017年1月至12月行CT检查的59例肺GGO患者,均接受CT引导下经皮穿刺活检,经手术、临床或随访结果证实。根据肺GGO轴位最大直径、实性成分所占比例、病变位置、距胸膜的距离、穿刺针-胸膜的角度、调针次数进行分组,采用单因素分析测定诊断的准确率、灵敏度、特异度及并发症的发生率。混合型GGO中实性成分≤50%和>50%之间的良恶性比较采用χ2检验。 结果 CT引导下经皮穿刺活检对59例周围孤立性肺GGO患者诊断的准确率、灵敏度和特异度分别为89.8%（53/59）、84.2%（32/38）、100%（21/21）,病理结果均证实为腺癌。根据方法中的不同分组,测定诊断的准确率较高且均≥80%,灵敏度均≥75%,特异度均为100%,但总体并发症的发生率较高。混合型GGO实性成分≤50%和>50%之间的良恶性比较,差异有统计学意义（χ2=6.13,P=0.01）。 结论 CT引导下经皮穿刺活检对周围孤立性肺GGO具有较高的诊断价值,GGO中实性成分比例与其恶性程度有一定的相关性。      

CT引导下经皮冷冻消融治疗肺磨玻璃结节的研究

目的 评价CT引导下经皮冷冻消融治疗肺磨玻璃结节的安全性和可行性.方法 2016年6月至2019年11月,28例肺磨玻璃结节患者中有13例为既往肺癌患者,15例为疑是肺肿瘤患者,共35枚结节,平均大小1.04 cm.患者接受了CT引导下同步穿刺活检及经皮冷冻消融,评估冷冻消融后的不良事件、肺功能和治疗效果.使用SPSS...     

CT引导下经皮肺穿刺活检术并发症的影响因素分析

目的探讨CT定位下经皮肺穿刺活检术并发症发生的影响因素。方法 CT引导下应用意大利PRECISA 18 G切割针对110例患者行经皮肺穿刺活检术,将患者的年龄、性别、病灶大小、切割组织块的多少、穿刺胸膜次数、穿刺时间、病灶深度、病灶周围炎症、慢性肺部病变等相关因素分为不同等级资料,卡方分析不同等级资料之间并发症发生率有无差异性,Logistic回归分析并发症发生的独立危险因素。结果 110例患者术后出现出血28例(占25.5%),气胸27例(占24.5%),卡方分析显示术后出血在病灶大小、病灶深度、穿刺时间及病灶周围炎症之不同组别之间存在差异性(P<0.05);术后气胸在穿刺胸膜次数、穿刺时间、病灶深度、慢性肺部病变之不同组间之间差异有统计学意义(P<0.05)。多因素Logistic回归分析显示病灶大小、病灶深度、病灶周围炎症在出血并发症中具独立危险因素,穿刺时间、穿刺胸膜的次数、慢性肺部病变在气胸并发症中具独立危险因素。结论肺穿刺活检术并发症的发生与病灶大小、穿刺胸膜次数、穿刺时间、病灶深度、病灶周围炎症、慢性肺部病变等相关。     

CT引导下经皮肺穿刺活检对不同大小肺结节的诊断效能及并发症相关因素分析

【摘要】目的：CT引导下经皮肺穿刺活检对不同大小肺结节的诊断效能,并分析并发症的相关影响因素。方法：回顾性分析2014年9月-2018年9月CT引导下经皮肺穿刺活检的202例患者的临床及穿刺数据资料。按结节大小分为直径（D）≤10mm组、10mm＜D≤20mm组、20mm＜D≤30mm组和D＞30mm组,分别统计各组穿刺活检诊断符合率。分别统计患者的年龄、性别、病灶大小、病灶密度、穿刺针穿越肺组织距离、取材组织数量等相关影响因素,采用χ2检验和Mann-Whitney U检验分析各因素组各并发症发生率的差异,Logistic回归分析并发症发生的危险因素。结果：所有病例均取材满意并进行组织病理学检查,各组诊断符合率分别为85.71%、84.13% 、83.64%和93.65%,差异无统计学意义;气胸的发生率为18.32%（37/202）,肺出血的发生率为19.80%（40/202）,咯血的发生率为0.99%（2/202）;影响气胸发生率的因素包括年龄（OR=1.037,95% CI：1.001～1.074,P=0.042）及穿刺针穿越肺组织距离（OR=1.030,95% CI：1.009～1.052,P=0.006）,且气胸发生率与两者均存在正相关;影响肺出血发生率的因素包括结节大小（OR=0.935,95% CI：0.895～0.977,P=0.003）及穿刺针穿越肺组织距离（OR=1.035,95% CI：1.013～1.058,P=0.002）,且肺出血发生率与结节大小呈负相关,与穿刺针穿越肺组织距离呈正相关。所有病例均未发生感染、针道种植转移及空气栓塞等严重并发症。结论：CT引导肺穿刺活检是安全、有效获得病理诊断的手段,适用于不同大小肺结节,具有可接受的较低的并发症发生率。     

CT引导下经皮肺穿刺活检方法改进初探

CT引导下经皮肺穿刺活检是目前胸部疾病诊断和鉴别诊断的重要手段,对于获取肺部病变的病理学诊断,具有较高的准确性,本研究旨在改进CT引导下经皮肺穿刺活检方法,以提高病理诊断率、减少并发症。     

高原地区CT引导下经皮穿刺肺结节的应用价值

目的 探讨高原地区CT引导下经皮穿刺肺结节的应用价值.方法 选取进行CT引导下经皮肺结节穿刺活检的98例患者,对术后影像资料及病理结果 进行回顾性分析.结果 98例肺活检96例穿刺成功(97.96％),其中恶性肿瘤66例,良性30例,失败2例;98例穿刺活检后32例出现并发症(32.65％),其中气胸14例,肺实质内出...     

CT导航下经皮肺小病灶穿刺活检的临床应用

目的探讨CT导航下肺小病灶经皮穿刺活检的临床应用价值。方法 56例肺内单发小结节病变(直径在0.8~2 cm)患者,在CT引导下应用18G自动活检针(或与之配套的带套管穿刺针)取材。均行组织病理学检查。结果 56例病例全部穿刺成功,53例肺小结节病变1次取材成功,成功率为94.64%,2例行2次取材成功,1例行3次取材成功。56例病理结果与手术或随访结果一致。该组7例出现少量气胸,1例中等量气胸,气胸发生率14.3%,10例肺出血,发生率17.9%,6例有少量咯血,1例中等量咯血,咯血发生率为12.5%。所有病例随访均未发生感染、肿瘤针道种植转移等并发症。结论 CT引导下自动切割针经皮活检肺小病灶(直径≤2 cm)诊断准确率高,并发症少,是一种安全、有效的临床诊断方法。     

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-guided percutaneous fine-needle aspiration biopsy of pulmonary nodules measuring 10 mm or less

AIM: To determine the value of computed tomography (CT)-guided fine-needle aspiration biopsy (FNAB) of small pulmonary nodules measuring 10 mm or less. MATERIAL AND METHODS: CT-guided FNABs of 55 nodules, measuring 10mm or less, were performed between January 2003 and February 2006. A coaxial technique was used, with an outer 19 G Bard Truguide needle and inner 22 G disposable Greene biopsy needle. Adequacy of specimens was assessed on-site by a cytotechnologist. The sizes of the nodules, distance from pleura, number of pleural punctures and aspirates, complications encountered, cytological diagnosis, and outcome were recorded. RESULTS: The mean nodule diameter was 9 mm (range 5-10 mm). The average distance from the costal pleura was 31 mm (range 0-88 mm). In 50 of the 55 FNABs, the pleura was crossed once. An average of four aspirates was performed per case. Twenty-five FNABs (45.5%) were adequate for diagnosis (24 malignant and one tuberculosis). In 11 cases, where no definite diagnosis was made following FNAB, the outcome was not affected. In 10 cases, samples were insufficient for diagnosis and the nodules were subsequently diagnosed as malignant. Eight cases were excluded in the final analysis as follow-up details were unavailable. The sensitivity for malignancy and overall accuracy were 67.7 and 78.8%, respectively. Pneumothorax occurred in 29 (52.7%) patients, with five (9.1%) requiring thoracostomy tubes. CONCLUSION: CT-guided FNAB is a useful tool in the diagnosis and management of small pulmonary nodules, despite the lower diagnostic accuracy and higher complication rate than those of larger pulmonary lesions.     

CT导向下肺中央型病变穿刺活检

目的：探讨CT导向下穿刺活检对肺中央型病变的可行性和安全性.方法：回顾性分析CT导向下穿刺活检的108例肺中央型病变患者的病例资抖,其中57例术前已行支气管镜检查但未取得明确结果.分析108例行穿刺活检的患者的活检阳性率和并发症发生率,并与随机抽取的同期108例肺周围型病变患者的结果进行甘比分析.结果：中央型病变组的活检阳性率（96.3%）与周围型组（98.2%）比较差异无显著性意义;总的并发症发生率中央型组（56.5%）明显高于周围型组（26.9%）,两组比较差异有显著性意义（P〈0.05）,但较严重并发症的发生率两组差异无显著性意义.57例支气管镜检查诊断不明确病例的活检阳性率为96.49%,并发症发生率63.16%.结论：对于肺中央型病变,只要严格掌握适应证,CT导向下穿刺活检是可行、安全和有效的,尤其适用于支气管镜检查无法明确诊断的病例.     

Meta-analysis of CT-guided transthoracic needle biopsy for the evaluation of the ground-glass opacity pulmonary lesions

Objective:

This meta-analysis is to determine the overall diagnostic yield of CT-guided transthoracic needle biopsy (TNB) of ground-glass opacity (GGO) lesions.

Methods:

A PubMed search was performed using “ground-glass opacity” crossed with “core biopsy” and “needle biopsy”. Test performance characteristics with the use of forest plots, summary receiver operating characteristic curves and bivariate random effects models were summarized. Adverse events, if reported, were recorded.

Results:

Our search identified 52 citations, of which 6 diagnostic studies evaluated 341 patients. Pooled specificity estimates were 0.94 [95% confidence interval (CI), 0.84–0.98] and sensitivity estimates were 0.92 (95% CI, 0.88–0.95), respectively. The positive likelihood ratio was 11.27 (95% CI, 4.2–30.6), the negative likelihood ratio was 0.1 (95% CI, 0.06–0.19), the diagnostic odds ratio was 131.38 (95% CI, 39.6–436.0) and the area under the curve was 0.97.

Conclusion:

Our data suggest that the CT-guided TNB is likely to be a useful tool for tissue diagnosis and may serve as an alternative for further patient management with GGO lesions. However, considering the limited studies and patients included, large scale studies are needed to verify these findings.

Advances in knowledge:

Some studies about CT-guided TNB of GGO lesions have been published, most have been small, single-institution case series. To our knowledge, our study is the first systematic analysis about CT-guided TNB of GGO lesions.Owing to the prevalence of lung cancer screening with low-dose CT, an increase in the detection of ground-glass opacity (GGO) lesions has been noted.^1–3 GGO is a finding on thin-section CT that is defined as “hazy increased attenuation of the lung with preservation of bronchial and vascular margins”.⁴ These characteristics may be caused by partial filling of air spaces, interstitial thickening, partial collapse of alveoli, normal expiration or increased capillary blood volume. It is known that GGO is a non-specific finding that may be caused by various disorders, including inflammatory disease, pulmonary fibrosis, alveolar haemorrhage or neoplasm.^5,6 The clinical significance of localized GGO is its high incidence of malignancy compared with solid nodules.^7,8 Kim et al⁹ reported that approximately 75% of focal pure GGO lesions are adenocarcinoma. Although it has been reported that the morphologic classification is helpful to differentiate malignant GGO lesions from benign conditions,⁸ it is generally considered very difficult based on CT findings alone.⁹ CT-guided biopsy is an established diagnostic technique that has high diagnostic yield and is used mainly for solid lung lesions.^10,11 Although some studies about CT-guided TNB of GGO lesions have been published, most have been small, single-institution case series. Figure 6 shows the procedure of CT-guided TNB for GGO lesions. The aim of this study was to systemically and quantitatively assess the diagnostic performance of CT-guided transthoracic needle biopsy (TNB) of GGO lesions.Open in a separate windowFigure 6.CT-guided core biopsy in 76-year-old male with ground-glass opacity (GGO) lesion in left lower lobe. CT scan obtained during biopsy shows biopsy needle targeting GGO lesion. Histologic diagnosis of core biopsy and surgical resection was adenocarcinoma.     

超声与CT经皮穿刺在超声可视性胸部病变定性诊断中的对比研究

目的 比较彩色超声(彩超)与CT经皮穿刺在超声可视性胸部病变定性诊断中的病灶刺中率、病理诊断阳性率以及并发症发生率.方法 回顾2015年1月至2016年6月影像学资料提示超声可视性胸部病变患者112例,病变与皮肤之间无骨骼及肺气遮挡,其中经超声引导下穿刺52例(超声组),经CT引导下穿刺60例(CT组),比较两组的病灶刺中率、病理诊断阳性率及并发症发生率.结果 超声组刺中率100％ (52/52),高于CT组91.7％ (55/60),超声组病理诊断阳性率为96.2％ (50/52),高于CT组80.0％ (48/60),超声组并发症发生率3.8％(2/52),低于CT组18.3％(11/60).结论 对于超声可视性胸部病变,超声引导下的穿刺活检较CT更加可靠.     

IG4电磁导航系统辅助CT引导下肺结节穿刺活检术的临床应用

目的 评价IG4电磁导航系统在CT引导下经皮穿刺肺活检术中的应用价值.方法 选择40例患者20例行IG4电磁导航系统辅助CT引导下肺穿刺活检,20例行常规CT引导下肺穿刺活检,记录2组定位时间、调针次数、扫描次数、辐射剂量、瞄准精度以及并发症情况.结果 IG4电磁导航系统辅助组中20例患者在穿刺过程中成功应用该系统,其肺活检平均定位时间为(10.05±1.75) min(7.5～14.0 min);穿刺针平均调整次数(1.10±0.31)次(1～5次);平均扫描次数为(3.30±0.73)次(3～6次);剂量长度乘积(DLP)均值为(724.25±186.23) mGy·cm (415.50～1 080.50 mGy·cm);20次穿刺定位中,15次瞄准精度＜5 mm,4次为5～ 10 mm,1次为13 mm,穿刺针瞄准精度均值为(4.72±3.33) mm(1～13 mm).常规穿刺组肺活检平均定位时间(15.10±2.40) min(11～19 min);穿刺针平均调整次数(4.05±1.32)次(3～7次);平均扫描次数为(6.05±1.32)次(5～9次),剂量长度乘积(DLP)均值为(1419.10±387.59) mGy·cm (900.50～1 958.90 mGy·cm).40例患者均无严重并发症发生.两组患者平均定位时间、平均穿刺针调整次数、平均扫描次数、剂量长度乘积均值对比差异均有统计学意义.结论 电磁导航系统辅助下CT引导肺穿刺活检术可缩短定位时间,减少调针次数、扫描次数,同时可减少患者接受的辐射剂量,是一种值得推广的影像引导新方法.