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

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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.	韩洪林, 孙景玲. CT 引导下经皮肺穿刺活检对肺部肿块的临床诊断价值. 现代医用影像学, 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.	任丽娜, 刘春芳, 徐健, 等. 超声支气管镜引导下支气管针吸活检在肺癌及纵隔肺门病变诊断中的应用价值. 中国肿瘤临床与康复, 2016, 23(1): 63-65.
5.	顾荣华. 胸腔镜下肺癌手术患者术中高发风险因素分析及护理配合. 国际护理学杂志, 2016, 35(5): 34-36.
6.	王晓平, 陈利军, 万毅新, 等. 393 例肺癌患者的电子支气管镜检查结果分析. 中国生物制品学杂志, 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. 纤支镜刷检与病理活检在肺癌诊断中的临床价值. 临床肺科杂志, 2013, 18(1): 24-25.
9.	Haaga JR, Alfidi RJ. Precise biopsy localization by computed tomography. Radiology, 1976, 118(3): 603-607.
10.	马永强, 韩嵩博, 杨宁. CT 引导经皮肺穿刺活检术对肺门肿块的诊断价值. 介入放射学杂志, 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, 王嗣伟, 李若梅, 等. CT 引导下经皮肺穿刺活检的临床价值. 中国 CT 和 MRI 杂志, 2011, 9(1): 7-9.
14.	张磊, 庄一平, 张晋, 等. CT 引导下经皮肺活检术诊断正确率及并发症的影响因素. 临床肿瘤学杂志, 2011, 16(4): 342-345.
15.	刘丽, 卲天朋, 曹建民, 等. CT 引导经皮穿刺活检术诊断孤立性肺结节. 中国介入影像与治疗学, 2016, 13(2): 73-76.
16.	黄惠, 曾丹, 程美清, 等. 超声引导经皮肺周围型肿物穿刺活检的临床应用. 影像诊断与介入放射学, 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.	黄勇, 杨云辉, 吕天甫, 等. CT 引导下经皮胸肺穿刺活检安全性和准确性分析. 实用医学影像杂志, 2013, 14(1): 65-67.
21.	李海丰, 谢国云. CT 引导下经皮肺内结节穿刺活检术的经验及护理. 影像技术, 2016, 28(2): 27-28.
22.	张宇东, 高斌, 李劲松, 等. CT 导引下 Angiotech 活检针在肺穿刺活检中临床应用. 安徽医学, 2014, 35(1): 33-35.
23.	马冬, 于韬, 郑文恒, 等. 调节多层螺旋 CT 扫描机架角度在经皮肺穿刺活检术中的应用. 肿瘤学杂志, 2016, 22(3): 222-225.

1. 韩洪林, 孙景玲. CT 引导下经皮肺穿刺活检对肺部肿块的临床诊断价值. 现代医用影像学, 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. 任丽娜, 刘春芳, 徐健, 等. 超声支气管镜引导下支气管针吸活检在肺癌及纵隔肺门病变诊断中的应用价值. 中国肿瘤临床与康复, 2016, 23(1): 63-65.
5. 顾荣华. 胸腔镜下肺癌手术患者术中高发风险因素分析及护理配合. 国际护理学杂志, 2016, 35(5): 34-36.
6. 王晓平, 陈利军, 万毅新, 等. 393 例肺癌患者的电子支气管镜检查结果分析. 中国生物制品学杂志, 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. 纤支镜刷检与病理活检在肺癌诊断中的临床价值. 临床肺科杂志, 2013, 18(1): 24-25.
9. Haaga JR, Alfidi RJ. Precise biopsy localization by computed tomography. Radiology, 1976, 118(3): 603-607.
10. 马永强, 韩嵩博, 杨宁. CT 引导经皮肺穿刺活检术对肺门肿块的诊断价值. 介入放射学杂志, 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, 王嗣伟, 李若梅, 等. CT 引导下经皮肺穿刺活检的临床价值. 中国 CT 和 MRI 杂志, 2011, 9(1): 7-9.
14. 张磊, 庄一平, 张晋, 等. CT 引导下经皮肺活检术诊断正确率及并发症的影响因素. 临床肿瘤学杂志, 2011, 16(4): 342-345.
15. 刘丽, 卲天朋, 曹建民, 等. CT 引导经皮穿刺活检术诊断孤立性肺结节. 中国介入影像与治疗学, 2016, 13(2): 73-76.
16. 黄惠, 曾丹, 程美清, 等. 超声引导经皮肺周围型肿物穿刺活检的临床应用. 影像诊断与介入放射学, 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. 黄勇, 杨云辉, 吕天甫, 等. CT 引导下经皮胸肺穿刺活检安全性和准确性分析. 实用医学影像杂志, 2013, 14(1): 65-67.
21. 李海丰, 谢国云. CT 引导下经皮肺内结节穿刺活检术的经验及护理. 影像技术, 2016, 28(2): 27-28.
22. 张宇东, 高斌, 李劲松, 等. CT 导引下 Angiotech 活检针在肺穿刺活检中临床应用. 安徽医学, 2014, 35(1): 33-35.
23. 马冬, 于韬, 郑文恒, 等. 调节多层螺旋 CT 扫描机架角度在经皮肺穿刺活检术中的应用. 肿瘤学杂志, 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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