320例胸部病变CT引导经皮穿刺活检总结

目的：评价CT引导经皮胸部穿刺术的诊断价值和并发症。材料和方法：收集资料完整的320例CT引导胸部穿刺活检病例作回顾性分析。肺部病变267例，纵隔病变30例，胸壁和胸膜病变23例。统计敏感性、特异性、准确性和并发症，并分析其影响因素。结果：191例穿刺确诊为恶性肿瘤。穿刺未发现癌细胞者129例，后经手术和随访证实其中属特征性阴性结果者58例，非特征性阴性结果46例，假阴性25例。未见假阳性，阳性预测值为100％（191／191），敏感性为88．4％（191／216），特异性为80．6％（104／129），准确性为92．2％（295／320），假阴性率为19．4％（25／129）。29例发生气胸，占9．1％（29／320），但仅1．6％（5／320）需要引流处理。肺出血12例，咯血12例，纵隔血肿8例，均为少量，不需处理。结论：CT引导经皮胸部穿刺是敏感性高和安全的定性诊断方法，降低假阴性是进一步提高准确性的关键。

Transthoracic Needle Biopsy under CT Guidance(a Report of 320 Cases)

To evaluate the diagnostic value and complications of transthoracic needle biopsy of thoracic masses and nodules under CT guidance.Materials and Method:320 patients who underwent transthoracic needle biopsy under CT guidance were collected.267 cases presented with pulmonary lesions,and 30 with mediastinal masses,other 23 cases with pleural and chest wall lesions.Both histopathologic and cytopathologic analyses were involved in all patients.Positive predictive value,sensitivity,specificity,accuracy rate,false-negative rate and pneumothorax occur rate were analysesed.Results:Biopsies in 191 cases yielded malignant lesions,carcinoma cells were not found,in 129 cases which specific-negative results were found in 58 cases,non-specific results in 46,and the renaining 25 cases were found to have false-negative results as the cases were leter proved to be cancer,by operation and follow-up.Positive predictive rate was 100%,sensitivity and specificity were 88.4% and 80.6%respectively,with total accuracy of 92.2%.No false-positive result was found,false-negative rate was 19.4%.Pneumothorax occured in 29(9.1%) of 320 cases,but chest tube placement and drainage were necessary in only five cases(1.6%).Conclusion:CT-guided transthoracic biopsy was a safe and valuable diagnostic method with high sensitivity,to decrease false-negative rate is a key to further improvement.