CT-Guided Percutaneous Lung Biopsy in Diagnosis of Pulmonary Nodules: 438 Cases Analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

HUMeng ¹ , FUYuanyuan ² ,  XIONGQiang ¹

1. Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R.China;
2. Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R.China;

Corresponding?author：

XIONGQiang, Email: 1985056904@qq.com

Keywords：

CT-guided percutaneous lung biopsy; Pulmonary nodules; Clinical significance; Safety analysis

DOI：

10.7507/1671-6205.201608035

Video：

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Objective To explore the diagnostic value and safety of CT-guided percutaneous lung biopsy (CT-PLB) for pulmonary nodules. Methods A total of 438 patients with pulmonary nodules underwent CT-PLB for further diagnosis. Results The CT-PLB was performed successfully in all 438 patients. The positive biopsy rate at the first puncture was 94.9%, and 100.0% at the second puncture. The pathology results revealed 379 (86.5%) cases of malignant lesions, 37 cases of benign lesions, and 22 cases with uncertainty. The sensitivity, specificity and accuracy of CT-PLB were 97.9% (376/384), 94.4% (51/54), and 97.4% (427/438), respectively. The first puncture induced complications included pneumothorax in 33 (7.5%) cases, blood in phlegm in 62 (14.2%) cases, pleural reaction in 7 (1.6%) cases, and bleeding at the site of puncture in 6 (1.4%) cases. There was no occurrence of neoplasm needle track implantation. The second puncture induced complications included pneumothorax in 7 (46.6%) cases and blood in phlegm in 11 (73.3%) cases. The incidences of pneumothorax and blood in phlegm were significantly higher in the patients with chronic obstructive pulmonary disease (COPD), with pulmonary lesion size＜3 cm, or with penetration depth ≥5 cm (P＜0.05). Conclusions CT-PLB is a safe method with a relatively small trauma and has good diagnostic value for pulmonary nodules. The incidence of complications increases in patients with smaller pulmonary lesions, deeper puncture, or COPD.

Citation： HUMeng, FUYuanyuan, XIONGQiang. CT-Guided Percutaneous Lung Biopsy in Diagnosis of Pulmonary Nodules: 438 Cases Analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(1): 34-39. doi: 10.7507/1671-6205.201608035 Copy

1.	?韓洪林, 孫景玲. CT 引導下經皮肺穿刺活檢對肺部腫塊的臨床診斷價值. 現代醫用影像學, 2016, 25(1): 23-26.
2.	Truong MT, Ko JP, Rossi SE, et al. Update in the evaluation of the solitary pulmonary nodule. Radiographics, 2014, 34(6): 1658-1679.
3.	Zhao XY, Tian J, Ru YH, et al. Application value of multislice spiral computed tomography angiography in the evaluation of renal artery variation in living donor kidney transplantation. Genet Mol Res, 2015, 14(1): 314-322.
4.	任麗娜, 劉春芳, 徐健, 等. 超聲支氣管鏡引導下支氣管針吸活檢在肺癌及縱隔肺門病變診斷中的應用價值. 中國腫瘤臨床與康復, 2016, 23(1): 63-65.
5.	顧榮華. 胸腔鏡下肺癌手術患者術中高發風險因素分析及護理配合. 國際護理學雜志, 2016, 35(5): 34-36.
6.	王曉平, 陳利軍, 萬毅新, 等. 393 例肺癌患者的電子支氣管鏡檢查結果分析. 中國生物制品學雜志, 2016, 29(2): 175-180.
7.	Rivera MP, Mehta AC, Wahidi MM. Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): 142-165.
8.	丁敏. 纖支鏡刷檢與病理活檢在肺癌診斷中的臨床價值. 臨床肺科雜志, 2013, 18(1): 24-25.
9.	Haaga JR, Alfidi RJ. Precise biopsy localization by computed tomography. Radiology, 1976, 118(3): 603-607.
10.	馬永強, 韓嵩博, 楊寧. CT 引導經皮肺穿刺活檢術對肺門腫塊的診斷價值. 介入放射學雜志, 2016, 25(3): 231-233.
11.	Chen J, Gao YD, Cao Y, et al. Surgical specimen histology revealed inadequacy of conventional transbronchial needle aspiration sample in the diagnosis of adenosquamous lung carcinoma. J Thorac Dis, 2015, 7(4): 680-686.
12.	Choi SH, Chae EJ, Kim JE, et al. Percutaneous CT-guided aspiration and core biopsy of pulmonary nodules smaller than 1 cm: analysis of outcomes of 305 procedures from a tertiary referral center. Am J Roentgenol, 2013, 201(5): 964-970.
13.	李群, 王嗣偉, 李若梅, 等. CT 引導下經皮肺穿刺活檢的臨床價值. 中國 CT 和 MRI 雜志, 2011, 9(1): 7-9.
14.	張磊, 莊一平, 張晉, 等. CT 引導下經皮肺活檢術診斷正確率及并發癥的影響因素. 臨床腫瘤學雜志, 2011, 16(4): 342-345.
15.	劉麗, 卲天朋, 曹建民, 等. CT 引導經皮穿刺活檢術診斷孤立性肺結節. 中國介入影像與治療學, 2016, 13(2): 73-76.
16.	黃惠, 曾丹, 程美清, 等. 超聲引導經皮肺周圍型腫物穿刺活檢的臨床應用. 影像診斷與介入放射學, 2016, 25(1): 65-68.
17.	Yamaki T, Wu CL, Gustin M, et al. Rel A/p65 is required for cytokine-induced myotube atrophy. Am J Physiol Cell Physiol, 2012, 303(2): C135-C142.
18.	Uruga H, Takaya H, Hanada S, et al. Diagnostic efficacy of CT-guided transthoracic needle biopsy and fine needle aspiration in cases of pulmonary infectious disease. Jpn J Radiol, 2012, 30(7): 589-593.
19.	Yaffe D, Koslow M, Haskiya H,et al.A novel technique for CT-guided transthoracic biopsy of lung lesions: improved biopsy accuracy and safety.Eur Radiol,2015,25(11):3354-3360.
20.	黃勇, 楊云輝, 呂天甫, 等. CT 引導下經皮胸肺穿刺活檢安全性和準確性分析. 實用醫學影像雜志, 2013, 14(1): 65-67.
21.	李海豐, 謝國云. CT 引導下經皮肺內結節穿刺活檢術的經驗及護理. 影像技術, 2016, 28(2): 27-28.
22.	張宇東, 高斌, 李勁松, 等. CT 導引下 Angiotech 活檢針在肺穿刺活檢中臨床應用. 安徽醫學, 2014, 35(1): 33-35.
23.	馬冬, 于韜, 鄭文恒, 等. 調節多層螺旋 CT 掃描機架角度在經皮肺穿刺活檢術中的應用. 腫瘤學雜志, 2016, 22(3): 222-225.

1. ?韓洪林, 孫景玲. CT 引導下經皮肺穿刺活檢對肺部腫塊的臨床診斷價值. 現代醫用影像學, 2016, 25(1): 23-26.
2. Truong MT, Ko JP, Rossi SE, et al. Update in the evaluation of the solitary pulmonary nodule. Radiographics, 2014, 34(6): 1658-1679.
3. Zhao XY, Tian J, Ru YH, et al. Application value of multislice spiral computed tomography angiography in the evaluation of renal artery variation in living donor kidney transplantation. Genet Mol Res, 2015, 14(1): 314-322.
4. 任麗娜, 劉春芳, 徐健, 等. 超聲支氣管鏡引導下支氣管針吸活檢在肺癌及縱隔肺門病變診斷中的應用價值. 中國腫瘤臨床與康復, 2016, 23(1): 63-65.
5. 顧榮華. 胸腔鏡下肺癌手術患者術中高發風險因素分析及護理配合. 國際護理學雜志, 2016, 35(5): 34-36.
6. 王曉平, 陳利軍, 萬毅新, 等. 393 例肺癌患者的電子支氣管鏡檢查結果分析. 中國生物制品學雜志, 2016, 29(2): 175-180.
7. Rivera MP, Mehta AC, Wahidi MM. Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): 142-165.
8. 丁敏. 纖支鏡刷檢與病理活檢在肺癌診斷中的臨床價值. 臨床肺科雜志, 2013, 18(1): 24-25.
9. Haaga JR, Alfidi RJ. Precise biopsy localization by computed tomography. Radiology, 1976, 118(3): 603-607.
10. 馬永強, 韓嵩博, 楊寧. CT 引導經皮肺穿刺活檢術對肺門腫塊的診斷價值. 介入放射學雜志, 2016, 25(3): 231-233.
11. Chen J, Gao YD, Cao Y, et al. Surgical specimen histology revealed inadequacy of conventional transbronchial needle aspiration sample in the diagnosis of adenosquamous lung carcinoma. J Thorac Dis, 2015, 7(4): 680-686.
12. Choi SH, Chae EJ, Kim JE, et al. Percutaneous CT-guided aspiration and core biopsy of pulmonary nodules smaller than 1 cm: analysis of outcomes of 305 procedures from a tertiary referral center. Am J Roentgenol, 2013, 201(5): 964-970.
13. 李群, 王嗣偉, 李若梅, 等. CT 引導下經皮肺穿刺活檢的臨床價值. 中國 CT 和 MRI 雜志, 2011, 9(1): 7-9.
14. 張磊, 莊一平, 張晉, 等. CT 引導下經皮肺活檢術診斷正確率及并發癥的影響因素. 臨床腫瘤學雜志, 2011, 16(4): 342-345.
15. 劉麗, 卲天朋, 曹建民, 等. CT 引導經皮穿刺活檢術診斷孤立性肺結節. 中國介入影像與治療學, 2016, 13(2): 73-76.
16. 黃惠, 曾丹, 程美清, 等. 超聲引導經皮肺周圍型腫物穿刺活檢的臨床應用. 影像診斷與介入放射學, 2016, 25(1): 65-68.
17. Yamaki T, Wu CL, Gustin M, et al. Rel A/p65 is required for cytokine-induced myotube atrophy. Am J Physiol Cell Physiol, 2012, 303(2): C135-C142.
18. Uruga H, Takaya H, Hanada S, et al. Diagnostic efficacy of CT-guided transthoracic needle biopsy and fine needle aspiration in cases of pulmonary infectious disease. Jpn J Radiol, 2012, 30(7): 589-593.
19. Yaffe D, Koslow M, Haskiya H,et al.A novel technique for CT-guided transthoracic biopsy of lung lesions: improved biopsy accuracy and safety.Eur Radiol,2015,25(11):3354-3360.
20. 黃勇, 楊云輝, 呂天甫, 等. CT 引導下經皮胸肺穿刺活檢安全性和準確性分析. 實用醫學影像雜志, 2013, 14(1): 65-67.
21. 李海豐, 謝國云. CT 引導下經皮肺內結節穿刺活檢術的經驗及護理. 影像技術, 2016, 28(2): 27-28.
22. 張宇東, 高斌, 李勁松, 等. CT 導引下 Angiotech 活檢針在肺穿刺活檢中臨床應用. 安徽醫學, 2014, 35(1): 33-35.
23. 馬冬, 于韜, 鄭文恒, 等. 調節多層螺旋 CT 掃描機架角度在經皮肺穿刺活檢術中的應用. 腫瘤學雜志, 2016, 22(3): 222-225.

Chinese Journal of Respiratory and Critical Care Medicine

CT-Guided Percutaneous Lung Biopsy in Diagnosis of Pulmonary Nodules: 438 Cases Analysis

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