Clinical application of multislice computed tomography-guided percutaneous transthoracic needle biopsy and influencing factors of its complications_West China Medical Journal

Authors：

ZHANG Hao ¹ , YANG Maojiang ² , QIONG Xian ² , LI Bing ² , ?ZHANG Chuan ² , LI Yang ² , YANG Hanfeng ² , YUAN Shu ³ ,  LI Haosheng ⁴

1. Department of Radiology, Dianjiang People’s Hospital, Dianjiang, Chongqing 408300, P. R. China;
2. Department of Radiology, the Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;
3. Department of Radiology, Ankang Hospital of Kai County, Kaixian, Chongqing 405400, P. R. China;
4. Department of Invasive Technology, Dianjiang People’s Hospital, Dianjiang, Chongqing 408300, P. R. China;

Corresponding?author：

LI Haosheng, Email: 236641765@qq.com

Keywords：

Multislice computed tomography-guided; Transthoracic needle biopsy; Clinical application; Complications

DOI：

10.7507/1002-0179.201609149

Video：

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Objective To investigate the clinical value and complication factors of percutaneous transthoracic needle biopsy (PTNB) guided by multislice computed tomography (MSCT). Methods From January 2013 to December 2016, 179 patients treated with MSCT-guided lung biopsy in the Affiliated Hospital of North Sichuan Medical College and Dianjiang People’s Hospital were reviewed. Occurrence rate and the influencing factors of complications were analyzed. Meanwhile, biopsy findings and diagnostic accuracy rate were summarized. Results A total of 129 cases of lung cancer were detected under MSCT-guided percutaneous biopsy in 179 patients with a diagnostic accuracy of 93.30%. The correct rate of malignant tumor diagnosis was 92.14%. The main complications were pneumothorax, pulmonary hemorrhage, dyspnea and hemoptysis. Major risk factors of MSCT-guided PTNB complications included lesion size ≤ 2 cm, the shortest distance to the diaphragm ≤ 5 cm, puncture depth > 5 cm, pleural puncture angle > 50°, the puncture times ≥ 2, puncture time ≥ 20 minutes, age of patients > 60 years, and existence of pulmonary disease (P<0.05). Conclusions The clinical application value of MSCT-guided PTNB is high. Skilled puncture technique and appropriate puncture procedure are helpful to reduce complications.

Citation： ZHANG Hao, YANG Maojiang, QIONG Xian, LI Bing, ?ZHANG Chuan, LI Yang, YANG Hanfeng, YUAN Shu, LI Haosheng. Clinical application of multislice computed tomography-guided percutaneous transthoracic needle biopsy and influencing factors of its complications. West China Medical Journal, 2017, 32(8): 1238-1242. doi: 10.7507/1002-0179.201609149 Copy

1.	張春芳, 陸珍鳳, 印洪林, 等. 642 例 CT 引導下經皮肺穿刺活檢病理診斷分析. 臨床與實驗病理學雜志, 2011, 27(4): 376-378, 381.
2.	Sconfienza LM, Mauri G, Grossi FA, et al. Pleural and peripheral lung lesions: comparison of US-and CT-guided biopsy. Radiology, 2013, 266(3): 930-935.
3.	王恩雨, 胡金文. CT 引導下經皮肺穿刺活檢術的臨床實踐. 放射學實踐, 2012, 27(4): 469-470.
4.	Wu CC, Maher MM, Shepard JA. Complications of CT-guided percutaneous needle biopsy of the chest: prevention and management. AJR Am J Roentgenol, 2011, 196(6): W678-W682.
5.	Hiraki T, Mimura H, Gobara H, et al. Incidence of and risk factors for pneumothorax and chest tube placement after CT fluoroscopy-guided percutaneous lung biopsy: retrospective analysis of the procedures conducted over a 9-year period. AJR Am J Roentgenol, 2010, 194(3): 809-814.
6.	Adiga S, Athreya S. Safety, efficacy, and feasibility of an ultra-low dose radiation protocol for CT-guided percutaneous needle biopsy of pulmonary lesions: initial experience. Clin Radiol, 2014, 69(7): 709-714.
7.	王斌, 伍安, 范曄, 等. CT 引導下經皮肺穿刺活檢對肺部惡性腫瘤的診斷價值. 中華醫學雜志, 2013, 93(38): 3023-3026.
8.	Li Y, Du Y, Luo TY, et al. Usefulness of normal saline for sealing the needle track after CT-guided lung biopsy. Clin Radiol, 2015, 70(11): 1192-1197.
9.	陳良安, 楊震, 王平. 肺癌早期診斷的新方法與評價. 中華結核和呼吸雜志, 2012, 35(2): 83-86.
10.	Braak SJ, van Strijen MJ, van Es HW, et al. Effective dose during needle interventions: cone-beam CT guidance compared with conventional CT guidance. J Vasc Interv Radiol, 2011, 22(4): 455-461.
11.	張孔源, 褚玉靜, 李林坤, 等. MSCT 后處理技術在經皮肺穿刺活檢中的立體定位研究. 中國醫學計算機成像雜志, 2014, 20(3): 242-245.
12.	倪穎夢, 時國朝, 萬歡英, 等. CT 引導下經皮肺穿刺的安全性及其影響因素. 中國呼吸與危重監護雜志, 2011, 10(2): 162-167.
13.	Li Y, Du Y, Yang HF, et al. CT-guided percutaneous core needle biopsy for small (≤20 mm) pulmonary lesions. Clin Radiol, 2013, 68(1): e43-e48.
14.	鄧偉吾, 時國朝. 實用臨床呼吸病學. 北京: 中國協和醫科大學出版社, 2004: 19-21.
15.	Cruz JF, Rolo R, Iglesias L, et al. CT-guided transthoracic lung biopsy: predictive factors of pneumothorax. Rev Port Pneumol, 2014, 20(3): 174-176.
16.	楊肖華, 黃新宇, 汪國祥. CT 引導下經皮肺穿刺活檢術并發癥的影響因素分析. 介入放射學雜志, 2013, 22(8): 658-662.
17.	陳萬海, 沈曉文, 孫新剛, 等. 經皮肺活檢常見并發癥風險因素分析. 介入放射學雜志, 2012, 21(2): 168-171.
18.	Patel MV, Ahmed O, Jilani D, et al. Computed tomography-guided percutaneous lung biopsy: impact of lesion proximity to diaphragm on biopsy yield and pneumothorax rate. J Thorac Imaging, 2014, 29(6): 344-349.
19.	虞德才, 張勇, 徐時宗, 等. 多窗技術聯合凝血酶封閉在 CT 導向下肺穿刺活檢術中的應用. 華西醫學, 2012, 27(3): 382-385.
20.	De Filippo M, Saba L, Concari G, et al. Predictive factors of diagnostic accuracy of CT-guided transthoracic fine-needle aspiration for solid noncalcified, subsolid and mixed pulmonary nodules. Radiol Med, 2013, 118(7): 1071-1081.

1. 張春芳, 陸珍鳳, 印洪林, 等. 642 例 CT 引導下經皮肺穿刺活檢病理診斷分析. 臨床與實驗病理學雜志, 2011, 27(4): 376-378, 381.
2. Sconfienza LM, Mauri G, Grossi FA, et al. Pleural and peripheral lung lesions: comparison of US-and CT-guided biopsy. Radiology, 2013, 266(3): 930-935.
3. 王恩雨, 胡金文. CT 引導下經皮肺穿刺活檢術的臨床實踐. 放射學實踐, 2012, 27(4): 469-470.
4. Wu CC, Maher MM, Shepard JA. Complications of CT-guided percutaneous needle biopsy of the chest: prevention and management. AJR Am J Roentgenol, 2011, 196(6): W678-W682.
5. Hiraki T, Mimura H, Gobara H, et al. Incidence of and risk factors for pneumothorax and chest tube placement after CT fluoroscopy-guided percutaneous lung biopsy: retrospective analysis of the procedures conducted over a 9-year period. AJR Am J Roentgenol, 2010, 194(3): 809-814.
6. Adiga S, Athreya S. Safety, efficacy, and feasibility of an ultra-low dose radiation protocol for CT-guided percutaneous needle biopsy of pulmonary lesions: initial experience. Clin Radiol, 2014, 69(7): 709-714.
7. 王斌, 伍安, 范曄, 等. CT 引導下經皮肺穿刺活檢對肺部惡性腫瘤的診斷價值. 中華醫學雜志, 2013, 93(38): 3023-3026.
8. Li Y, Du Y, Luo TY, et al. Usefulness of normal saline for sealing the needle track after CT-guided lung biopsy. Clin Radiol, 2015, 70(11): 1192-1197.
9. 陳良安, 楊震, 王平. 肺癌早期診斷的新方法與評價. 中華結核和呼吸雜志, 2012, 35(2): 83-86.
10. Braak SJ, van Strijen MJ, van Es HW, et al. Effective dose during needle interventions: cone-beam CT guidance compared with conventional CT guidance. J Vasc Interv Radiol, 2011, 22(4): 455-461.
11. 張孔源, 褚玉靜, 李林坤, 等. MSCT 后處理技術在經皮肺穿刺活檢中的立體定位研究. 中國醫學計算機成像雜志, 2014, 20(3): 242-245.
12. 倪穎夢, 時國朝, 萬歡英, 等. CT 引導下經皮肺穿刺的安全性及其影響因素. 中國呼吸與危重監護雜志, 2011, 10(2): 162-167.
13. Li Y, Du Y, Yang HF, et al. CT-guided percutaneous core needle biopsy for small (≤20 mm) pulmonary lesions. Clin Radiol, 2013, 68(1): e43-e48.
14. 鄧偉吾, 時國朝. 實用臨床呼吸病學. 北京: 中國協和醫科大學出版社, 2004: 19-21.
15. Cruz JF, Rolo R, Iglesias L, et al. CT-guided transthoracic lung biopsy: predictive factors of pneumothorax. Rev Port Pneumol, 2014, 20(3): 174-176.
16. 楊肖華, 黃新宇, 汪國祥. CT 引導下經皮肺穿刺活檢術并發癥的影響因素分析. 介入放射學雜志, 2013, 22(8): 658-662.
17. 陳萬海, 沈曉文, 孫新剛, 等. 經皮肺活檢常見并發癥風險因素分析. 介入放射學雜志, 2012, 21(2): 168-171.
18. Patel MV, Ahmed O, Jilani D, et al. Computed tomography-guided percutaneous lung biopsy: impact of lesion proximity to diaphragm on biopsy yield and pneumothorax rate. J Thorac Imaging, 2014, 29(6): 344-349.
19. 虞德才, 張勇, 徐時宗, 等. 多窗技術聯合凝血酶封閉在 CT 導向下肺穿刺活檢術中的應用. 華西醫學, 2012, 27(3): 382-385.
20. De Filippo M, Saba L, Concari G, et al. Predictive factors of diagnostic accuracy of CT-guided transthoracic fine-needle aspiration for solid noncalcified, subsolid and mixed pulmonary nodules. Radiol Med, 2013, 118(7): 1071-1081.

West China Medical Journal

Clinical application of multislice computed tomography-guided percutaneous transthoracic needle biopsy and influencing factors of its complications

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