Okajima Yuji, Tajima Hiroyuki, Kumazaki Tatsuo, Onda Munehiko
Departments of Radiology, Center for Advanced Medical Technology, Nippon Medical School, Japan.
J Nippon Med Sch. 2002 Oct;69(5):434-44. doi: 10.1272/jnms.69.434.
Prior reports of CT-guided lung biopsy of the small lung nodules of less than 2 cm have been unsatisfactory. In January 1998, we began a preliminary study of CT-guided lung biopsy in our conventional CT room. With the basic results achieved, we constructed a novel CT-guided lung biopsy system. Together with Hitachi Corporation we have developed CT, the Radix Prima, exclusive for interventional procedures especially for CT-guided lung biopsy. As reconstruction delay time of the procedures has been shortened from 1.0 sec. to 0.6 sec., real time CT fluoroscopy monitoring is possible on the Cathode Ray Tube (CRT) monitor in the CT room, very closed to the patient. Multiple confirmations of the tip of the biopsy needle have been possible with this specially equipped CT. A semi-automatic-type needle have been selected for reliable biopsy, because the old fully-automatic-type needle was very heavy and easily misfired. Multiple punctures have been also used, because single punctures have a greater risk of obtaining inadequate specimens. In our clinical study at our IVR center, the subjects comprised 41 patients (26 males, 15 females, ranging in age from 34 to 79, mean 64 years old). The mean nodule diameter was 1.9 cm, the mean distance from skin surface to lesion was 5.5 cm, and the mean number of punctures was 3.0. The biopsy results included 23 malignancies. In 13 patients the results were benign tumors or specific inflammation. In 4 patients the results were nonspecific inflammation. In only 1 patient was the specimen inadequate. There was no false negative. The correct rate of benign/malignant diagnoses was 98%. A complication of pneumothorax was observed in 22 patients, but all were improved by conservative treatment. Pulmonary hemorrhage was observed in 21 patients, 7 of whom also had hemoptysis. Each of these patients also responded to conservative treatment from specialist medical staff at the IVR center. The 98%accuracy of our results indicates that multiple punctures using a semi-automatic-type biopsy needle and multiple confirmations of the needle tip on our method of real time CT fluoroscopy are extremely important for CT-guided lung biopsy of small lung nodules of less than 2 cm.
先前关于CT引导下对直径小于2厘米的肺小结节进行肺活检的报告并不理想。1998年1月，我们在常规CT室开始了CT引导下肺活检的初步研究。在取得基本成果后，我们构建了一种新型的CT引导下肺活检系统。我们与日立公司共同开发了专门用于介入操作尤其是CT引导下肺活检的CT——Radix Prima。由于操作的重建延迟时间从1.0秒缩短至0.6秒，因此可以在CT室中非常靠近患者的阴极射线管（CRT）监视器上进行实时CT透视监测。使用这种特殊装备的CT能够对活检针的针尖进行多次确认。由于老式的全自动型活检针非常重且容易出现故障，所以选择了半自动型活检针以确保可靠的活检。还采用了多次穿刺，因为单次穿刺获取标本不足的风险更大。在我们介入放射学中心的临床研究中，研究对象包括41例患者（男性26例，女性15例，年龄在34岁至79岁之间，平均64岁）。结节平均直径为1.9厘米，从皮肤表面到病灶的平均距离为5.5厘米，平均穿刺次数为3.0次。活检结果包括23例恶性肿瘤。13例患者的结果为良性肿瘤或特异性炎症。4例患者的结果为非特异性炎症。仅1例患者的标本不足。无假阴性结果。良恶性诊断的正确率为98%。22例患者出现气胸并发症，但均通过保守治疗得到改善。21例患者出现肺出血，其中7例还伴有咯血。这些患者中的每一位也都在介入放射学中心接受了专业医护人员的保守治疗。我们的研究结果显示98%的准确率表明，对于直径小于2厘米的肺小结节进行CT引导下肺活检，使用半自动型活检针进行多次穿刺以及在我们的实时CT透视方法下对针尖进行多次确认极为重要。
