CT导引下胸部病变穿刺活检的临床分析

目的：评价CT导引下穿刺活检在胸部病变诊断中的价值。方法：有手术病理或临床随诊的胸部病变CT穿刺活检223例，其中125例133次活检为传统CT导引下活检，其余98例105次CT穿刺活检应用激光导引装置。结果：223例胸部病变中212例有临床诊断结果，CT穿刺活检诊断正确率为82．1％（174／212），对恶性病变的敏感率86．2％（131／152），特异性100％、对良性病变明确诊断率为71．7％（43／60）。并发症包括13．0％（31／238）发生气胸，1．3％（3／238）需要放胸腔引流管，5．0％（1／238）发生肺实质少量出血，0．8％（2／238）出现少量咳血。激光导引下CT穿刺活检诊断正确率为88．4％（84／95），明显高于传统CT导引下活检76．9％（90／117）的诊断正确率，两者在气胸发生率、每次活检平均胸膜穿刺次数方面无统计学差异。结论：CT导引下胸部病变穿刺活检是一种安全、准确、有效的诊断及鉴别诊断方法。激光导引装置在胸部CT穿刺活检中有较高的应用价值，尤其对于小病灶和中心性病变。与传统CT导引下活检相比激光导引下CT活检可提高诊断证确率、缩短活检时间。

Clinical application with CT-guided percutaneous transthoracic aspiration biopsy

Objective:To evaluate the clinical application of CT-guided percutaneous transthoracic aspiration biopsy.Methods:CT-guided percutaneous transthoracic biopsy 223 cases.All 223 cases had surgical pathology or clinical follow-up,of which 98 cases(105 biopsies) were performed with laser-guidance device,125 cases(133 biopsies) with conventional CT guidence.Results:212 of 223 lesions have final diagnoses.CT-guided biopsy showed 82.1%(174/212) overall accuracy,86.2%(131/152) sensitivity,100% specificity and 71.7%(43/60) specific diagnosis of benign lesions.Complications included pneumothorax in 31(13%) of 238 biopsies;chest tube insertion in 3(1.3%) of 238 biopsies: minor pulmonary hemorrhage in 12(5%) of 238 biopsies;and hemoptysis in 2(0.8%) of 238 biopsies.Laser-guided biopsy was superior to conventional CT-guidad biopsy for the overall diagnostic accuracy(88.4% for laser-guidence versus 76.9% for conventional CT-guidance.There were no statistical difference in pneumothorax rate,biopsy time between laser-guided CT biopsy and conventional CTguided biopsy.Conclusion:CT-guided percutaneous transthoracic aspiration biopsy wasa quick,safe and effitive method for diagnosis and differential diagnosis.Laser-guidance device was quite helpful for CT biopsy,especially for small nodules and central lesions.Compared with conventional CT-guided biopsy,laser-guided CT biopsy significantly increased the overall diagnositic accuracy and decreased biopsy time.