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

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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.	张春芳, 陆珍凤, 印洪林, 等. 642 例 CT 引导下经皮肺穿刺活检病理诊断分析. 临床与实验病理学杂志, 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 引导下经皮肺穿刺活检术的临床实践. 放射学实践, 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, 范晔, 等. CT 引导下经皮肺穿刺活检对肺部恶性肿瘤的诊断价值. 中华医学杂志, 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.	陈良安, 杨震, 王平. 肺癌早期诊断的新方法与评价. 中华结核和呼吸杂志, 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.	张孔源, 褚玉静, 李林坤, 等. MSCT 后处理技术在经皮肺穿刺活检中的立体定位研究. 中国医学计算机成像杂志, 2014, 20(3): 242-245.
12.	倪颖梦, 时国朝, 万欢英, 等. CT 引导下经皮肺穿刺的安全性及其影响因素. 中国呼吸与危重监护杂志, 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.	邓伟吾, 时国朝. 实用临床呼吸病学. 北京: 中国协和医科大学出版社, 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.	杨肖华, 黄新宇, 汪国祥. CT 引导下经皮肺穿刺活检术并发症的影响因素分析. 介入放射学杂志, 2013, 22(8): 658-662.
17.	陈万海, 沈晓文, 孙新刚, 等. 经皮肺活检常见并发症风险因素分析. 介入放射学杂志, 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, 张勇, 徐时宗, 等. 多窗技术联合凝血酶封闭在 CT 导向下肺穿刺活检术中的应用. 华西医学, 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. 张春芳, 陆珍凤, 印洪林, 等. 642 例 CT 引导下经皮肺穿刺活检病理诊断分析. 临床与实验病理学杂志, 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 引导下经皮肺穿刺活检术的临床实践. 放射学实践, 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, 范晔, 等. CT 引导下经皮肺穿刺活检对肺部恶性肿瘤的诊断价值. 中华医学杂志, 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. 陈良安, 杨震, 王平. 肺癌早期诊断的新方法与评价. 中华结核和呼吸杂志, 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. 张孔源, 褚玉静, 李林坤, 等. MSCT 后处理技术在经皮肺穿刺活检中的立体定位研究. 中国医学计算机成像杂志, 2014, 20(3): 242-245.
12. 倪颖梦, 时国朝, 万欢英, 等. CT 引导下经皮肺穿刺的安全性及其影响因素. 中国呼吸与危重监护杂志, 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. 邓伟吾, 时国朝. 实用临床呼吸病学. 北京: 中国协和医科大学出版社, 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. 杨肖华, 黄新宇, 汪国祥. CT 引导下经皮肺穿刺活检术并发症的影响因素分析. 介入放射学杂志, 2013, 22(8): 658-662.
17. 陈万海, 沈晓文, 孙新刚, 等. 经皮肺活检常见并发症风险因素分析. 介入放射学杂志, 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, 张勇, 徐时宗, 等. 多窗技术联合凝血酶封闭在 CT 导向下肺穿刺活检术中的应用. 华西医学, 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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