纵隔肿块CT导向经皮穿刺活检的精确性和安全性

目的 探讨CT导向经皮穿刺活检对纵隔肿块诊断的临床应用价值和限度。方法 回顾经组织学诊断证实的CT导向经皮纵隔肿块穿刺活检24例，12例直接途径穿刺，12例经肺途径穿刺。计算精确诊断率和两种穿刺途径并发症情况。结果 24例中22例获得足够的活检组织样本(92％)，16例各种类型肺癌中，14例组织学分型诊断精确(87．5％)，4例淋巴瘤只有1例诊断精确(25％)。直接途径穿刺气胸发生率0(0/12)，经肺途径穿刺气胸发生率42％(5/12)。结论 纵隔肿块CT导向经皮穿刺活检是有效的获取组织学诊断的方法，其并发症与穿刺途径相关，直接途径穿刺安全性高，可广泛应用；其限度在于获取的组织样本有限，有时不能满足对淋巴瘤的诊断。

Diagnostic accuracy and safety of CT-guided percutaneous needle biopsy in mediastinal masses

Objective To evaluate the role of CT-guided transcutaneous needle biopsy for diagnosis of mediastinal masses.Methods The medical records and imaging studies in 24 patients who underwent percutaneous mediastinal biopsy were reviewed.Direct mediastinal approach and transpulmonary approach were used in 12 patients respectively.And the rate of accuracy diagnosis and complication was calculated.Results Adequate material for diagnosis was obtained in 22 of 24 patients(92%).Sixteen of 24 patients had various types lung cancer.Identification of the different histotypes was correct at needle biopsy in 14 (87.5%) of 16patiens.Only one of 4 lymphoma was diagnosted accuracy.Pneumothorax occurred in 5 of 24 patients(21%).This high complication rate was associated with the use of the transpulmonary approach.Conclusion CT-guided transcutaneous needle biopsy is a effective procedure to establish histologic diagnosis of accessible mediastinal masses.But the biopsy speciments is limited and sometimes it is not adequate to establish histologic diagnosis of lymphoma.