CT引导下经皮肺穿刺对肺亚实性结节病变的诊断价值及安全性评价

目的 探讨CT引导下经皮肺穿刺活检对亚实性结节(sub-solid nodule)的诊断价值及安全性能。 方法 回顾性分析26例因肺部亚实性结节于蚌埠医学院第一附属医院接受CT引导下经皮肺穿刺患者的临床资料及随访资料,计算该技术对亚实性结节诊断的准确度,对恶性亚实性结节诊断的敏感度、特异度和并发症发生率。 结果 26例肺部亚实性结节病变均一次穿刺成功取材,成功率为100%,恶性肿瘤12例(12/26,46.15%),腺癌8例,腺鳞癌1例,鳞癌2例,差分化癌1例,腺癌合并真菌感染1例;良性病变14例(14/26,53.85%),其中1例微量炎性细胞浸润,间质稍增生,超声内镜证实为腺癌;曲霉菌病1例,炎症8例(其中2例慢性炎症的患者经抗炎治疗后病灶有所进展,外院手术结果为腺癌,余6例慢性炎患者经抗感染治疗后病愈);1例肺组织间质血管轻度扩张充血(经抗感染治疗后吸收,证实为炎症),1例有少数分化良好的鳞状上皮(经抗感染治疗后吸收),肺结核2例。2例患者穿刺活检后出现少量气胸(7.69%),5例患者出现少量咯血(19.23%)。CT引导下经皮肺穿刺对肺部亚实性结节病因确诊率为84.62%(22/26),对恶性亚实性结节诊断的敏感度、特异度分别为80.00%(12/15)、100%,并发症率为26.92%,严重并发症率为0%。 结论 CT引导下经皮肺穿刺活检可以安全、有效地诊断肺部亚实性病变。 

Diagnostic value and safety of percutaneous lung biopsy under CT guidance for sub-solid nodules lesions

Objective To evaluate the diagnostic value and safety of percutaneous lung biopsy under CT guidance for sub-solid nodules lesions. Methods The clinical data and follow-up data of 26 cases of pulmonary sub-solid nodules lesions that performing percutaneous lung biopsy under CT guidance in our hospital were analyzed retrospectively. The ratio of correct diagnosis of sub-solid nodules, diagnostic sensitivity diagnostic specificity of malignant sub-solid nodules and the incidence of complications were calculated. Results Each tissue was successfully obtained from 26 cases of pulmonary solid nodules by once puncture. The success rate of puncture was 100%. Twelve cases (12/26, 46.15%) of malignant tumors were diagnosed. Eight cases were adenocarcinoma, 1 case was adenosquamous carcinoma, 2 cases were squamous cell carcinoma, 1 case was poorly differentiated carcinoma, 1 case adenocarcinoma accompanied with fungal infection. Fourteen cases were benign lesions (14/26, 53.85%), 1 case of them was infiltrated with small amount of inflammatory cells and interstitial hyperplasia that diagnosed as adenocarcinoma by endobronchial ultrasonography later; 1 case was aspergillosis and 8 cases were inflammation (2 cases of patients with chronic inflammatory had progressed after the anti-inflammatory treatment and they were diagnosed as adenocarcinoma in other hospital after resection. The remaining 6 patients with chronic inflammation were all healed after anti-infective treatment); 1 case with mild interstitial vasculature dilatation and congestion was confirmed as inflammation after anti-infective treatment. One case diagnosed as a few well-differentiated squamous epitheliums, which was absorbed after anti-infection treatment. Two cases of tuberculosis were diagnosed. Small pneumothorax was found in 2 patients (7.69%). Small amount of hemoptysis occurred in 5 patients (19.29%). The ratio of correct diagnosis of sub-solid nodules performed by CT-guided percutaneous pulmonary puncture was 84.62%(22/26). The sensitivity and specificity of the diagnosis of malignant sub-solid nodules were 80% (12/15) and 100%, the incidence of complications was 26.92%, the incidence of severe complications was 0%. Conclusion CT-guided percutaneous puncture biopsy can safely and effectively diagnose pulmonary ground glass opacity lesions.