CT引导下经皮肺穿刺活检术对肺小结节诊断价值

目的探讨CT引导下经皮肺穿刺活检对直径≤20mm肺实性结节、磨玻璃结节及混合性结节不同密度肺结节的临床诊断价值。方法回顾性分析了2017年1月至2019年6月期间109例直径≤20mm肺小结节于本院行CT引导下经皮肺穿刺活检病例资料,分析不同亚类肺小结节穿刺活检取材、病理结果及术中术后并发症等情况。结果109例肺结节病灶直径≤20mm的患者均顺利完成CT引导下肺穿刺活检术,穿刺活检成功率为100%,89例患者得以病理明确诊断,阳性率为81.7%(89/109),肺实性结节、纯磨玻璃结节及混合磨玻璃结节诊断率分别为91.7%、69.6%及88.9%,纯磨玻璃结节穿刺诊断率与实性及混合磨玻璃结节比较差异具有统计学意义(P<0.05);病灶大小5~10 mm穿刺诊断率为70.6%,10~20 mm穿刺诊断率为83.7%,两者比较差异无统计学意义(P>0.05);术中术后气胸、出血发生率分别为9.1%和32.1%例,其中实性结节、纯磨玻璃结节和混合磨玻璃结节,气胸发生率分别为11.1%、8.7和7.4%,三者比较差异无统计学意义(P>0.05);实性结节、纯磨玻璃结节和混合磨玻璃结节出血发生率分别为11.1%、45.7%和37.0%;实性结节、纯磨玻璃结节及混合磨玻璃结节比较差异有统计学意义(P<0.05)。结论CT引导下经皮肺穿刺活检术对于≤2 mm以下肺实性结节、混合磨玻璃结节及纯磨玻璃结节有较高诊断价值,但纯磨玻璃结节穿刺诊断率低,且纯磨玻璃结节及混合磨玻璃结节出血发生率高,在临床工作中对不同密度的肺小结节行穿刺活检时应引起重视。

Diagnostic value of CT-guided percutaneous lung biopsy for small pulmonary nodules

Objective To evaluate the clinical diagnostic value of CT-guided percutaneous needle biopsy(PNB)for small pulmonary solid nodules,pure ground-class nodules and mixed ground-glass nodules with diameter≤20 mm.Methods The data of 109 patients undergoing CT-guided percutaneous needle biopsy of small pulmonary nodules(≤20 mm)from January 2017 to June 2019 in our hospital were collected,and the sampling of different subtypes of nodules,pathological results and intraoperative and postoperative complications were analyzed retrospectively.Results A total of 109 cases of small pulmonary nodules were punctured and technical success of CT-guided PNB for small(≤20 mm)lung nodules was 100%.89 patients were definitely pathological diagnosed,with a diagnosis rate of 81.7%(89/109).The diagnostic rates of pulmonary solid nodules,pure ground-class nodules and mixed ground-glass nodules were 91.7%,69.6%and 88.9%respectively(P<0.05).The diagnosis rates of lesions among 5~10 mm and 10~20 mm in diameter were 70.6%and83.7%(P>0.05).The total incidence of complications of pneumothorax and pulmonary hemorrhage was 9.1%and 32.1%respectively.The incidence of complications of pneumothorax insolid nodules,pure ground-class nodules and mixed ground-glass nodule was 11.1%,8.7%and 7.4%(P>0.05).The incidence of pulmonary hemorrhage in pulmonary solid nodules,pure ground-class nodules and mixed ground-glass nodules were 11.1%,45.7%and 37%respectively(P<0.05).Conclusion CT-guided percutaneous needle biopsy(PNB)has high diagnostic value for small pulmonary solid nodules,pure ground-class nodules and mixed ground-glass nodules with diameter≤20 mm.However,the diagnosis rate of pure ground-class nodules is lower,and the complication of hemorrhage of pure ground-class nodules and mixed ground-glass nodules is higher.Therefore,we should pay more attention to the puncture biopsy of small pulmonary nodules with different densities in clinical work.