Computed tomography-navigated transthoracic core biopsy of pulmonary lesions:: Which factors affect diagnostic yield and complication rates?
Computed tomography-navigated transthoracic core biopsy of pulmonary lesions:: Which factors affect diagnostic yield and complication rates?
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DOI：
10.1016/j.acra.2008.02.018
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发表时间：
2008-08-01
影响因子：
4.8
通讯作者：
Nicolas, Volkmar
中科院分区：
文献类型：
--
作者：
Heyer, Christoph M.;Reichelt, Stefanie;Nicolas, Volkmar
理论基础和目标。只有少数研究系统地评估了CT引导下经胸肺活检(TLB)中气胸和肺出血的危险因素。我们评估CT引导下TLB术的诊断率，并确定胸膜腔积液和出血的危险因素。172例患者(平均年龄66岁+/-11岁，其中72%为男性)在CT引导下使用16号核心活检针进行TLBS检查。记录病变和患者特征、肺功能分析、肺气肿的CT征象、组织病理学诊断和并发症。采用多元回归分析方法进行统计分析。病理诊断符合者153例(%)。尽管在组织病理学诊断中，病变大小较大(47+/-29对43+/-35 mm，P=.191)，深度较低(22+/-23对6+/-23 mm，P=.350)，但不同的参数对诊断率有显著影响。诊断恶性肿瘤的敏感性和特异性分别为93%和100%，阳性预测值和阴性预测值分别为100%和88%。总体准确率为95%。发生气胸45例(26%)。发生出血17例(10%)。病灶较小(35+/-23对50+/-31 mm，优势比=0.96)和深度较大(29+/-29对20.19 mm，P=0.05；优势比=1.03)的患者气胸发生率较高。肺气肿的CT征象显示出血发生率较高(35%比23%；P=0.04；优势比=41.03)。其他参数均无统计学意义。CT引导下TLB的高诊断率不受病变特征或肺气肿的影响。气胸发生率受病变大小和深度的影响。出血与肺气肿的CT征象有关。
Rationale and Objectives. Only a few studies have systematically evaluated risk factors for pneumothorax and pulmonary hemorrhage in computed tomographically (CT)-guided transthoracic lung biopsy (TLB). We evaluated the diagnostic yield of CT-guided TLB and determined risk factors for pneurnothorax and hemorrhage.Methods. One hundred seventy-two CT-guided TLBs were performed on 159 patients (mean age 66 +/- 11 years; 72% male) using a 16-gauge core biopsy needle. Lesion and patient characteristics, lung function analysis, CT signs of emphysema, histopathologic diagnoses, and complications were recorded. Statistical analysis was performed with multivariate regression analysis.Results. Histopathologic diagnosis was established in 153 cases (89%). Although lesion size was higher (47 +/- 29 vs. 43 +/- 35 mm, P =.191) and depth was lower (22 +/- 23 vs. 6 +/- 23mm, P =.350) in procedures with histopathologic diagnosis, no.parameter showed significant impact on diagnostic yield. Sensitivity and specificity for detection of malignancy were 93% and 100%, respectively, whereas positive and negative predictive values were 100% and 88%. Overall accuracy was 95%. Pneumothorax occurred in 45 procedures (26%). Hemorrhage was recorded in 17 procedures (10%). There was higher frequency of pneumothorax in smaller lesions (35 +/- 23 vs. 50 +/- 31 mm, P =.003; odds ratio =.96) and greater depth (29 +/- 29 vs. 20 19 mm, P =.05; odds ratio = 1.03). CT signs of emphysema revealed higher incidence of hemorrhage (35% vs. 23%; P =.04; odds ratio=41.03). Other parameters were nonsignificant.Conclusions. The high diagnostic yield of CT-guided TLB was not affected by lesion characteristics or emphysema. Pneumothorax rate was influenced by lesion size and depth. Hemorrhage was associated with CT signs of emphysema.