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.
ObjectiveTo assess the feasibility of 3D digital lung software used in preoperative planning of patients with multiple pulmonary nodules and poor pulmonary function. MethodsFive patients with multiple pulmonary nodules in the left lung, meanwhile with a history of single lung lobectomy in the right lung were included in our hospital between June and December 2015. There were 4 males and 1 female at an average age of 50.4±2.6 years. A 320-slice volumetric CT scanner was used to the CT angiography (CTA) of the pulmonary artery. The data of CT images were imported into the 3D digital lung software that was researched and developed by Xiamen QiangBen Science and Technology Company. The 3D reconstruction of digital virtual lung was completed by this software based on those data. At the same time the soft-ware completed the automatic segmentation of the lung based on the pulmonary artery system and the 3D reconstruction of the pulmonary nodules. The 3D digital lung software calculated the volume proportion of the intended removal (segm-ental lesions) to the whole lung, estimated the effect of surgery on forced expired volume in one second (FEV1), and the patient's tolerance ability to surgery. After the preoperative planning, the patients received multiple pulmonary segmental/subsegmental resection under the general anesthesia by video-assisted thoracoscopic surgery (VATS). ResultsThe 3d reconstruction of the pulmonary arteries reached 5 levels in 5 patients. And the software automatically identified out the lung segment/subsegment to show the lung nodules of lung segment/subsegment. The preselection lung volume of 5 patients accounted for 14.00%-27.00% of total lung volume. The software estimated FEV1 as 1.16-1.46 L which can tolerate the operation. The 5 patients were successfully performed surgery of multiple pulmonary segmental/subsegmental resection under the general anesthesia by VATS. The software located lung nodules from the resection of pulmonary segments during operation immediately. Then we sent them to the rapid pathological examination for diagnosis. After operation, the patients recovered well, and had no respiratory insufficiency. Hospitalization day was 4 days. ConclusionThe 3D digital pulmonary software can not only automatically identify the pulmonary segments, precisely position the pulmonary nodule, show the relationship among the target pulmonary segments artery, vein, bronchus and the surroun-ding artery, vein, and bronchus, but also calculate the volume of the pulmonary segments, estimate the impact of the pulmonary segmentectomy on the FEV1. It is useful for precise evaluation of the tolerant capacity of multiple pulmonary nodules in patients with unstaged multiple pulmonary segments.