CT引导下经皮穿刺肺部局灶性磨玻璃结节42例
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摘要
目的探讨CT引导下经皮穿刺肺部局灶性磨玻璃密度结节(focal ground-glass opacity,f GGO)的临床应用价值。方法搜集42例经皮穿刺肺部局灶性磨玻璃结节病例,对穿刺病理结果及术后影像资料进行回顾性分析。结果 42例肺穿刺活检,穿刺成功率97.6%(41/42),明确恶性病变35例(83.3%),良性病变7例(16.7%),追踪到15例恶性病变进行手术,3例穿刺病理诊断原位癌,术后病理诊断升级为浸润性腺癌,1例不典型腺瘤样增生术后病理升级为原位癌,穿刺活检病理与术后病理诊断相符率(73.3%)。并发症有气胸5例(11.9%),肺实质内出血8例(19.0%),咯血4例(9.5%),胸腔内少量出血2(4.7%)。结论 CT引导下经皮穿刺活检对于肺部磨玻璃病变获取组织细胞病理学诊断,操作简单,准确性高,并发症少,对磨玻璃病变定性诊断具有较高的应用价值。
Objective To assess the clinical application value of CT-guided percutaneous puncture needle biopsy for pulmonary focal ground-glass opacity(f GGO). Methods A total of 42 patients with pulmonary focal glass nodule were collected. The pathological results and postoperative imaging findings were retrospectively analyzed. Results CT-guided percutaneous puncture needle biopsy was performed in all 42 patients. The success rate of puncturing was 97.6%(41/42). The diagnosis of malignancy was confirmed in 35 patients(83.3%), and benign lesion was proved in 7 patients(16.7%). Fifteen patients with pulmonary malignancy underwent surgery, in 3 patients the preoperative diagnosis by puncture needle biopsy was carcinoma in situ, and the postoperative pathological diagnosis was invasive adenocarcinoma; in one patient the preoperative diagnosis by puncture needle biopsy was atypical adenomatous hyperplasia, and the postoperative pathological diagnosis was carcinoma in situ. The diagnostic coincidence rate of puncture biopsy pathology with postoperative pathological diagnosis was 73.3%. The complications included pneumothorax(n=5, 11.9%), pulmonary parenchymal hemorrhage(n=8, 19.0%), hemoptysis(n=4, 9.5%), and small amount of hemothorax(n=2, 4.7%). Conclusion CT-guided percutaneous puncture biopsy for pulmonary f GGO can get its histopathological diagnosis. This method is technically-simple with high diagnostic accuracy and less complications. It has a high application value for qualitative diagnosis of f GGO.
Objective To assess the clinical application value of CT-guided percutaneous puncture needle biopsy for pulmonary focal ground-glass opacity(f GGO). Methods A total of 42 patients with pulmonary focal glass nodule were collected. The pathological results and postoperative imaging findings were retrospectively analyzed. Results CT-guided percutaneous puncture needle biopsy was performed in all 42 patients. The success rate of puncturing was 97.6%(41/42). The diagnosis of malignancy was confirmed in 35 patients(83.3%), and benign lesion was proved in 7 patients(16.7%). Fifteen patients with pulmonary malignancy underwent surgery, in 3 patients the preoperative diagnosis by puncture needle biopsy was carcinoma in situ, and the postoperative pathological diagnosis was invasive adenocarcinoma; in one patient the preoperative diagnosis by puncture needle biopsy was atypical adenomatous hyperplasia, and the postoperative pathological diagnosis was carcinoma in situ. The diagnostic coincidence rate of puncture biopsy pathology with postoperative pathological diagnosis was 73.3%. The complications included pneumothorax(n=5, 11.9%), pulmonary parenchymal hemorrhage(n=8, 19.0%), hemoptysis(n=4, 9.5%), and small amount of hemothorax(n=2, 4.7%). Conclusion CT-guided percutaneous puncture biopsy for pulmonary f GGO can get its histopathological diagnosis. This method is technically-simple with high diagnostic accuracy and less complications. It has a high application value for qualitative diagnosis of f GGO.
引文
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[9]马永强,韩嵩博,杨宁.CT引导经皮肺穿刺活检术对肺门肿块的诊断价值[J].介入放射学杂志,2016,25:231-233.
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[2]严高武,严高文,孙清泉,等.CT引导下经皮肺穿刺活检对肺部毛玻璃样病变良恶性的诊断价值[J].中国循证医学杂志,2016,16:378-382.
[3]Westcott JL,Rao N,Colley DP.Transthoracic needle biopsy of small pulmonary nodules[J].Radiology,1997,202:97-103.
[4]Shimo T,Nakanishi T,Kimura Y,et al.Inhibition of endogenous expression of connective tissue growth factor by its antisense oligonucleotide and antisense RNA suppresses proliferation and mlgration of vascular endothelial cells[J].J Biochem,1998,124:130-140.
[5]Lee IJ,Bae YA,Kim DG,et al.Percutaneous needle aspiration biopsy(PCNAB)of lung lesions:5 years results with focusing on repeat PCNAB[J].Eur J Radiol,2010,73:551-554.
[6]Jae LI,June IH,Miyeon Y,et al.Percutaneous core needle biopsy for small(≤10 mm)lung nodules:accurate diagnosis and complication rates[J].Diagn Interv Radiol,2012,18:527-530.
[7]陈克敏,黄蔚,吴志远.CT引导下肺活检和并发症的预防[J].介入放射学杂志,2011,20:163-165.
[8]蒋保华,张进,黄云海,等.CT引导18 G-Bard Magnum活检针在肺穿刺活检中并发症的发生因素[J].介入放射学杂志,2015,24:792-796.
[9]马永强,韩嵩博,杨宁.CT引导经皮肺穿刺活检术对肺门肿块的诊断价值[J].介入放射学杂志,2016,25:231-233.
[10]沈健,陈珑,倪才方,等.CT引导下经皮穿刺同轴活检术在肺部病变诊断中的应用[J].实用放射学杂志,2014,30:108-110.
[11]Wiener RS,Schwartz LM,Woloshin S,et al.Population-based risk for complications after transthoracic needle lung biopsy of a pulmonary nodule:an analysis of discharge records[J].Ann Intern Med,2011,155:137-144.
[12]Yildirim E,Kirbas I,Harman A,et al.CT-guided cutting needle lung biopsy using modified coaxial technique:factors effecting risk of complications[J].Eur J Radiol,2009,70:57-60.