CT-guided biopsy of lung nodules with pleural contact: Comparison of two puncture routes
CT-guided biopsy of lung nodules with pleural contact: Comparison of two puncture routes
复制标题
CT引导下胸膜接触肺结节活检：两种穿刺路径的比较
DOI：
10.1016/j.diii.2021.05.005
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发表时间：
2021
影响因子：
5.5
通讯作者：
Kanazawa Susumu
中科院分区：
文献类型：
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作者：
Iguchi Toshihiro;Hiraki Takao;Matsui Yusuke;Tomita Koji;Uka Mayu;Tanaka Takashi;Munetomo Kazuaki;Gobara Hideo;Kanazawa Susumu
目的回顾性比较两种穿刺途径（经胸膜vs.经肺）进行计算机断层扫描（CT）透视引导下胸膜接触肺结节切割针活检。（72名男性;平均年龄，71.1 ± 9.5 [SD]岁），102例肺结节的102次活检（平均尺寸，16.7 ± 5.9 [SD] mm;范围，6.0-29.4 mm;胸膜接触的平均长度，10.1 ± 4.2 [SD] mm;范围，2.8-19.6 mm）。所有手术均分为直接经胸膜途径或经肺途径活检。患者，病变，活检相关的变量，诊断收益率，并发症的发生率进行了比较between the two routes. ResultsLivopsy是通过直接经胸膜途径（n= 59; 57.8%）和transplanaries路由（n= 43; 42.2%）。在经肺穿刺组中，肺内通路的平均距离为17.7 ± 9.4 [SD] mm（范围：4.1-47.6 mm;P< 0.001），观察到穿刺针轨迹角度显著< 45°（8.5% [5/59] vs. 60.5% [26/43];P< 0.001）。直接经胸膜和经肺途径的诊断准确率无显著差异（93.2% [55/59] vs. 90.7% [39/43];P= 0.718）。所有并发症的频率（64.4% [38/59] vs. 97.7% [42/43];P< 0.001），气胸（33.9% [20/59] vs. 65.1% [28/43];P= 0.003），气胸伴胸管置入（3.4% [2/59] vs. 18.6% [8/43];P= 0.016）和肺出血（47.5% [28/59] vs. 76.7% [33/43]; P= 0.004）在直接经胸膜组中显著降低。与胸膜接触的肺结节引导活检，因为它比经肺途径更安全，诊断准确性相似。
PurposeThe purpose of this study was to retrospectively compare two puncture routes (transpleuralvs.transpulmonary) for computed tomography (CT) fluoroscopy-guided cutting needle biopsy of lung nodules with pleural contact.Patients and methodsA total of 102 patients (72 men; mean age, 71.1 ± 9.5 [SD] years) were included and 102 biopsies of 102 lung nodules (mean size, 16.7 ± 5.9 [SD] mm; range, 6.0–29.4 mm; mean length of pleural contact, 10.1 ± 4.2 [SD] mm; range, 2.8–19.6 mm) were analyzed. All procedures were classified as biopsies via the direct transpleural route or the transpulmonary route. The patient-, lesion-, and biopsy-related variables, diagnostic yields, and incidence of complications were compared between the two routes.ResultsBiopsy was performed via the direct transpleural route (n= 59; 57.8%) and transpulmonary route (n= 43; 42.2%). In the transpulmonary route group, the mean distance of the intrapulmonary pathway was 17.7 ± 9.4 [SD] mm (range: 4.1–47.6 mm;P< 0.001) and the introducer needle trajectory angle of < 45° was significantly observed (8.5% [5/59] vs. 60.5% [26/43];P< 0.001). There was no significant difference in diagnostic accuracy between the direct transpleural and transpulmonary routes (93.2% [55/59] vs. 90.7% [39/43];P= 0.718). The frequencies of all complications (64.4% [38/59] vs. 97.7% [42/43];P< 0.001), pneumothorax (33.9% [20/59] vs. 65.1% [28/43];P= 0.003), pneumothorax with chest tube placement (3.4% [2/59] vs. 18.6% [8/43];P= 0.016), and pulmonary hemorrhage (47.5% [28/59] vs. 76.7% [33/43];P= 0.004) were significantly lower in the direct transpleural group.ConclusionDirect transpleural route is recommended for CT fluoroscopy-guided biopsy of lung nodules with pleural contact because it is safer and yields similar diagnostic accuracy than transpulmonary route.