Geraghty Patricia R, Kee Stephen T, McFarlane Gillian, Razavi Mahmood K, Sze Daniel Y, Dake Michael D
Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5105, USA.
Radiology. 2003 Nov;229(2):475-81. doi: 10.1148/radiol.2291020499.
To evaluate the effect of coaxial needle size on pneumothorax rate and the diagnostic accuracy of computed tomography (CT)-guided transthoracic needle aspiration biopsy (TNAB) of pulmonary nodules.
Retrospective review of 846 consecutive CT-guided TNAB procedures was performed. A coaxial approach was implemented in all patients by using an 18- or 19-gauge outer stabilizing needle through which a smaller aspiration needle or automated biopsy gun was inserted for tissue sampling. Univariate and multivariate regression analyses were used to analyze coaxial needle size, age, sex, smoking history, lesion size, use of an automated core biopsy gun, number of needle passes, and frequency of chest tube placement. Sensitivity, specificity, and diagnostic accuracy were calculated for 676 patients with at least 18 months of clinical follow-up.
Pneumothorax occurred in 226 of 846 patients. Coaxial needle size and patient age had a significant effect on pneumothorax rate. Pneumothorax occurred in 124 (38%) of 324 patients who underwent procedures with 18-gauge needles and in 121 (23%) of 522 patients who underwent procedures with 19-gauge needles (P <.001). The overall diagnostic accuracy was 96% for procedures performed with 18-gauge needles and 92% for procedures performed with 19-gauge needles, with a sensitivity of 95% and 89% and a specificity of 100% and 99%, respectively. Pneumothorax occurred in 153 patients older than 60 years, in 99 patients 60 years and younger (P <.02), in 90 patients older than 70 years, and in 162 patients younger than 70 years (P <.01). The relationship between pneumothorax rate and age as a continuous distribution was not significant (P <.07), nor were the 50- or 75-year age cutoffs (P <.06 and P <.9, respectively).
Use of a smaller coaxial stabilizing needle produces a substantially decreased risk of pneumothorax with comparable diagnostic accuracy, sensitivity, and specificity for histopathologic diagnosis of pulmonary nodules.
评估同轴针尺寸对气胸发生率以及计算机断层扫描（CT）引导下经胸针吸活检（TNAB）诊断肺结节准确性的影响。
对846例连续的CT引导下TNAB操作进行回顾性分析。所有患者均采用同轴穿刺法，使用18号或19号外固定针，通过该针插入较细的抽吸针或自动活检枪进行组织采样。采用单因素和多因素回归分析来分析同轴针尺寸、年龄、性别、吸烟史、病变大小、自动活检枪的使用、穿刺次数以及置胸管频率。对676例至少有18个月临床随访的患者计算敏感性、特异性和诊断准确性。
846例患者中有226例发生气胸。同轴针尺寸和患者年龄对气胸发生率有显著影响。324例使用18号针进行操作的患者中有124例（38%）发生气胸，522例使用19号针进行操作的患者中有121例（23%）发生气胸（P <.001）。使用18号针进行操作的总体诊断准确性为96%，使用19号针进行操作的为92%，敏感性分别为95%和89%，特异性分别为100%和99%。60岁以上患者中有153例发生气胸，60岁及以下患者中有99例（P <.02），70岁以上患者中有90例，7岁以下患者中有162例（P <.01）。气胸发生率与年龄作为连续分布之间的关系不显著（P <.07），50岁或75岁的年龄界限也不显著（分别为P <.06和P <.9）。
使用较细的同轴固定针可显著降低气胸风险，对肺结节组织病理学诊断具有相当的诊断准确性、敏感性和特异性。
