CT-Guided Transthoracic Needle Aspiration Biopsy of Subsolid Lung Lesions

PurposeTo assess the diagnostic performance of computed tomography (CT)–guided transthoracic needle aspiration biopsy (TNAB) in the evaluation of persistent subsolid lung lesions.Materials and MethodsA retrospective review of all CT-guided TNABs performed at a single institution from January 2002 to November 2012 was conducted to identify patients with persistent subsolid lung lesions. The diagnostic performance of CT-guided TNAB was assessed through comparison of cytologic diagnoses with core needle biopsy, surgical resection, or imaging and clinical follow-up. The cytologic, histologic, and imaging features of each lesion were characterized, and CT-guided TNAB complications were recorded.ResultsIn 32 patients, a diagnosis of benign or malignant disease was identified through evaluation of pathologic or follow-up data. There were 18 men and 14 women, with a mean age of 67.1 years ± 9.6 (range, 52–86 y). The mean lesion diameter was 21 mm ± 11 (range, 8–62 mm). A final diagnosis of malignancy was made in 28 cases (87.5%); four benign lesions were also diagnosed. The overall sensitivity of CT-guided TNAB in the evaluation of these lesions was 89.2%, and the specificity and positive predictive value were 100%. Two pneumothoraces (6.3%) were identified.ConclusionsAmong patients with subsolid lung lesions, CT-guided TNAB is safe and shows high sensitivity. The high specificity and positive predictive value of the procedure allow for definitive treatment decisions to be made for most patients.     

CT导向经皮肺活检的临床应用

31例肺部肿块病人在CT导向下作了经皮针吸肺活检术,其中肺癌16例,肺穿刺活检准确率87.5%;良性病变15例,肺穿刺活检准确率93%、术后气胸3例(9.7%),小量出血1例(3.2%).CT扫描图像清晰.病灶定位准确.因此CT导向经皮肺活检术安全、准确、成功率高,在肺部肿块的诊断中有重要作用.     

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。     

Protective Capnothorax During Transthoracic Needle Biopsy

CardioVascular and Interventional Radiology - Transthoracic needle biopsy (TTNB) is an established procedure in the management of pulmonary nodules. The most common complications are directly...     

CT-Guided Transthoracic Biopsy of Lung Lesions Using a Non-Coaxial Biopsy Needle Technique: CT Characteristics Predictive for Diagnostic Accuracy and Pneumothorax

Objectives:To analyze computed tomography (CT) characteristics predictive for diagnostic accuracy and pneumothorax in CT fluoroscopy-guided transthoracic biopsy (CTF-TTB) of lung lesions using non-coaxial biopsy needle technique.Methods:Retrospectively 274 lung lesion biopsies with confirmed histology were included in our study. CTF-TTB was done using an 18-gauge non-coaxial cutting needle. Diagnostic accuracy rates were calculated per lesion size and CT and procedural characteristics were evaluated for their predictive value regarding diagnostic accuracy and development of pneumothorax (maximal nodule diameter, distance to pleura, location per lung segment, nodule composition, benign versus malignant histology, and number of specimens).Results:Overall diagnostic accuracy of CTF-TTB was high (93%). Diagnostic accuracy for lesions ≤10 mm was 81%. Maximal nodule diameter was the only predictive CT characteristic for diagnostic success (p = 0.03). Pneumothorax occurred in 27%. Distance of lesion to pleura was the only risk factor for pneumothorax (p < 0.00001). Pneumothorax rates were significantly lower in subpleural lesions (14%) compared to those located 1–10 mm (47%), 10–20 mm (33%), and >20 mm from pleura (29%).Conclusions:High diagnostic accuracy rates were achieved with CTF-TTB using non-coaxial biopsy technique, even for lesions ≤10 mm. Pneumothorax rates were comparable with other studies. Lesion size was the only predictive CT characteristic for diagnostic accuracy. Distance to pleura was the only risk factor for pneumothorax.     

Imaging of Post Transthoracic Needle Biopsy Complications

When faced with characterization of a suspicious lung lesion, transthoracic needle biopsy (TTNB) is the standard technique used to retrieve a pathological specimen. Usual complications reported for this intervention are pneumothorax, hemorrhage, air embolism, and tumor seeding. This pictorial essay illustrates imaging of these complications.     

透视引导经皮细针穿刺活检肺癌假阴性的相关因素分析

目的探讨肺癌病灶经皮细针穿刺抽吸活检假阴性结果产生的相关因素和避免方法。资料与方法回顾性研究60例在电视透视下(有1例加用CT引导)行经皮针吸肺活检的病例．追踪肺穿刺细胞学结果与手术病理或临床随访结果。分类记录假阴性病灶的操作人员、病理结果、术中发现和病灶CT特征。结果发现假阴性14例(20．3％)。恶性病灶直径3～5cm,深度≥4cm,有坏死或继发感染．则易致穿刺假阴性。结论经皮细针穿刺抽吸活检肺内病灶时一定要仔细分析病灶特征并熟练掌握相应的穿刺技巧．尽量避免发生假阴性。     

螺旋CT引导下细针经皮肺穿活检术的临床运用

目的探讨螺旋CT引导下细针抽吸式经皮肺穿刺活检的临床应用价值。方法回顾性分析我科进行的125例经皮肺穿刺活检病例,均为肺内或胸壁单发或多发肿块。结果125例患者穿刺成功125例,共穿刺130个肿块,明确诊断102例,其中肺鳞癌22例,肺腺癌45例,转移瘤5例,胸膜间皮瘤2例,淋巴瘤1例,肺吸虫病l例,肺内血肿l例,尘肺3例,肺错构瘤1例,炎性假瘤5例,结核瘤3例;13例未做病理分类,只报告查见癌细胞。穿刺活检总确诊率为81.6%,仅发生气胸7例。结论螺旋CT引导下细针抽吸式经皮肺穿刺活检术操作简便、费用低廉、检出阳性率高,并发症少,是一种简便、安全实用的检查方法。     

Cone-Beam CT-Guided Percutaneous Transthoracic Needle Lung Biopsy of Juxtaphrenic Lesions: Diagnostic Accuracy and Complications

ObjectiveTo investigate the diagnostic accuracy and complications of cone-beam CT-guided percutaneous transthoracic needle biopsy (PTNB) of juxtaphrenic lesions and identify the risk factors for diagnostic failure and complications.Materials and MethodsIn total, 336 PTNB procedures for lung lesions (mean size ± standard deviation [SD], 4.3 ± 2.3 cm) abutting the diaphragm in 326 patients (189 male and 137 female; mean age ± SD, 65.2 ± 11.4 years) performed between January 2010 and December 2014 were included. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the PTNB procedures for the diagnosis of malignancy were measured based on the intention-to-diagnose principle. The risk factors for diagnostic failures and complications were evaluated using logistic regression analysis.ResultsThe accuracy, sensitivity, specificity, PPV, and NPV were 92.7% (293/316), 91.3% (219/240), 91.4% (74/81), 96.9% (219/226), and 77.9% (74/95), respectively. There were 23 diagnostic failures (7.3%), and lesion sizes ≤ 2 cm (p = 0.045) were the only significant risk factors for diagnostic failure. Complications occurred in 98 cases (29.2%), including 89 cases of pneumothorax (26.5%) and 7 cases of hemoptysis (2.1%). The multivariable analysis showed that old age (> 65 years) (p = 0.002), lesion size of ≤ 2 cm (p = 0.003), emphysema (p = 0.006), and distance from the pleura to the target lesion (> 2 cm) (p = 0.010) were significant risk factors for complications.ConclusionThe diagnostic accuracy of cone-beam CT-guided PTNB of juxtaphrenic lesions for malignancy was fairly high, and the target lesion size was the only significant predictor of diagnostic failure. Complications of cone-beam CT-guided PTNB of juxtaphrenic lesions occurred at a reasonable rate.     

CT引导下肺门病变的穿刺针吸活检

目的：探讨CT引导下肺门病变穿刺针吸活检的成功因素。方法：搜集肺门病变患者资料42例,采用Shimadzu CT引导,5mm层厚扫描,21G抽吸针;穿刺时尽可能在胸壁内调整好进针方向,首选经过阻塞性不张、炎性病变、粘连组织进入病灶,其次穿刺的距离最短,避开坏死组织,识别所取材料的可靠性。结果：总符合率为90．5％,误诊2例,不能明确诊断2例,未发生1例严重并发症。结论：CT导引下肺门病变针吸活检是在周围型病变穿刺活检基础上的技术进步,是获得肺门病变病理的又一项有效选择。     

Combined Fluoroscopy- and CT-Guided Transthoracic Needle Biopsy Using a C-Arm Cone-Beam CT System: Comparison with Fluoroscopy-Guided Biopsy

Objective

The aim of this study was to evaluate the usefulness of combined fluoroscopy- and CT-guided transthoracic needle biopsy (FC-TNB) using a cone beam CT system in comparison to fluoroscopy-guided TNB (F-TNB).

Materials and Methods

We retrospectively evaluated 74 FC-TNB cases (group A) and 97 F-TNB cases (group B) to compare their respective diagnostic accuracies according to the size and depth of the lesion, as well as complications, procedure time, and radiation dose.

Results

The sensitivity for malignancy and diagnostic accuracy for small (< 30 mm in size) and deep (≥ 50 mm in depth) lesions were higher in group A (91% and 94%, 92% and 94%) than in group B (73% and 81%, 84% and 88%), however not statistically significant (p > 0.05). Concerning lesions ≥ 30 mm in size and < 50 mm in depth, both groups displayed similar results (group A, 91% and 92%, 80% and 87%; group B, 90% and 92%, 86% and 90%). Pneumothorax occurred 26% of the time in group A and 14% for group B. The mean procedure time and patient skin dose were significantly higher in group A (13.6 ± 4.0 minutes, 157.1 ± 76.5 mGy) than in group B (9.0 ± 3.5 minutes, 21.9 ± 15.2 mGy) (p < 0.05).

Conclusion

Combined fluoroscopy- and CT-guided TNB allows the biopsy of small (< 30 mm) and deep lesions (≥ 50 mm) with high diagnostic accuracy and short procedure times, whereas F-TNB is still a useful method for large and superficial lesions with a low radiation dose.     

艾滋病并发症中CT引导下经皮肺穿刺活检术的应用

目的：探讨CT引导下经皮穿刺活检术在艾滋病肺部病变中的应用、诊断价值及其暴露防护。方法：回顾性分析16例经皮肺穿刺活检的相关资料,男10例,女6例,平均年龄28.7岁;其中单个病灶7例,多发块影或结节影5例,大片实变影4例,合并纵隔淋巴结肿大4例,合并胸水3例。结果：所有病例均穿刺成功,16例患者行18例次穿刺,12例病例获得诊断,其中肺结核6例,真菌感染3例,细菌感染3例,诊断符合率66.7%;不能明确诊断4例。术后并发症：病灶周围出血5例,少量气胸3例。无医护人员暴露感染。结论：CT引导下经皮肺穿刺活检较为安全,有利于患者早期诊断,操作应严格预防暴露感染。     

Chest Wall Dissemination of Nocardiosis after Percutaneous Transthoracic Needle Biopsy

We described a case of chest wall dissemination after percutaneous transthoracic needle biopsy. A 65-year-old man had a lung nodule which was suspected to be lung carcinoma. He underwent percutaneous transthoracic needle biopsy using an 18G semiautomated biopsy needle and pathologic diagnosis showed organizing pneumonia. Two months after the biopsy, chest wall dissemination occurred. Implantation of carcinoma along the biopsy route was suspected, but the mass was actually due to pulmonary nocardiosis.     

孤立性肺结节的CT引导下经皮肺穿刺活检

目的　探讨CT引导下经皮肺穿刺活检术对孤立性肺结节的诊断价值。方法　回顾性分析于 1993 -0 3～ 2 0 0 1-0 3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的资料完整的 61例孤立性肺结节病灶。采用美国Cook公司的抽吸式活检针和套管式自动活检枪 ,选择最佳穿刺层面及穿刺点获取标本。结果　 61例孤立性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 47例 (原发性支气管肺癌 43例 ,转移癌 4例 ) ,良性病变者 14例。而CT引导下经皮肺穿刺活检诊断为恶性肿瘤者 43例 ,良性病变者 9例。并发症 :气胸 12例 (19.8% ) ,出血 5例 (8.2 % ) ,咯血 4例 (6.6% )。结论　孤立性肺结节的CT引导下经皮肺穿刺活检是一种创伤小而实用的定性诊断方法 ,具有较高的临床应用价值     

激光导引装置在胸部病变CT导引穿刺活检中的应用

目的　评价激光导引装置在胸部病变CT导引穿刺活检中的作用。资料与方法　有手术病理或临床随访的胸部病变CT穿刺活检 335例 ,其中 1 39例应用激光导引装置 (激光组 ) ,其余 1 96例无激光导引装置 (非激光组 )。依据手术病理、临床随访结果对活检病变作出最后诊断。比较激光组与非激光组在诊断正确率、并发症发生率方面有无差别。P <0 .0 5定义为有显著性差异。结果　激光组诊断正确率为 90 .6 % (1 2 6/ 1 39) ,明显高于非激光组 82 .7% (1 62 / 1 96)的诊断正确率 (χ2 =4.31 ,P =0 .0 379)。对于直径 >3cm的病灶 ,激光组和非激光组诊断正确率相近 (分别为 93 .3 %和 89.7% ,χ2 =0 .60 ,P =0 .44) ,但对≤ 3cm的病灶 ,激光组诊断正确率明显高于非激光组 (分别为 88.6 %和 77.1 % ,χ2 =4.1 2 ,P =0 .0 4 2 3) ;对于紧贴胸膜病灶 ,激光组诊断正确率 (94.6 % )略高于非激光组(91 .5 % ) ,两者之间无统计学差异 (χ2 =0 .30 ,P =0 .5833) ,对于非紧贴胸膜病灶 ,激光组诊断正确率 (89.2 % )明显高于非激光组 (79.9% ) (χ2 =3 .87,P =0 .0 4 90 )。激光组和非激光组气胸发生率分别为 1 2 .2 % (1 7/ 1 39)和 1 2 .8%(2 5/ 1 96) (χ2 =0 .0 1 ,P =0 .92 73)。结论　激光导引装置在经皮胸部CT导引穿刺活检     

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。     

CT导向纵隔淋巴结针吸活检对肺癌的诊断意义

目的探讨CT导向纵隔淋巴结经皮针吸活检对支气管肺癌的诊断意义.方法1992-10～1998-09期间随机选择142例临床疑为原发性肺癌并有纵隔淋巴结增大(直径≥10mm)的病例,在CT扫描监控下,使用国产秦氏针进行185次针刺活检与细胞学检查.结果经手术(98例)、尸检(6例)与1年以上随访(25例)证实敏感性为82%,特异性为100%.结论CT导向经皮针刺纵隔淋巴结活检是一简便而又可靠的诊断方法,对支气管肺癌的诊断与分期有重要价值.     

Helical-Tip Needle for Transthoracic Percutaneous Image-Guided Biopsy of Lung Tumors: Results of a Pilot Prospective Comparative Study with a Standard Tru-Cut Needle

CardioVascular and Interventional Radiology - To prospectively evaluate feasibility and diagnostic performance of the 14-gauge helical-tip (Spirotome™, Cook® Medical, Bloomington, USA)...     

Air Embolism Detected During Computed Tomography Fluoroscopically Guided Transthoracic Needle Biopsy

Air embolism is a rare but potentially fatal complication of percutaneous needle biopsy of the lung. We report a case of cerebral air embolism which occurred during computed tomography (CT)-guided needle biopsy. Air entering the aorta is depicted on CT-fluoroscopy images of the procedure.     

CT引导肺穿刺活检诊断肺炎型肺癌的价值研究

目的：探讨CT引导肺穿刺活检术诊断肺炎型肺癌的临床价值。方法：搜集26例首诊为炎性病变,后经临床病理证实为肺癌患者的病例资料,将其中确诊前接受了CT引导肺部病变穿刺活检术的19例作为本组研究病例进行回顾性分析。结果：根据CT引导肺部病变穿刺活检物获得病理诊断为腺癌12例,细支气管肺泡癌6例,肺泡上皮乳头状重度异型不典型增生1例（手术证实为乳头状腺癌）。本组病例CT引导肺穿刺活检物病检阳性率为100%。结论：CT引导肺穿刺活检术对明确肺炎型肺癌的诊断有重要价值。