Saa-Gandi F W, Mearns A J
Department of Surgery, General Hospital, Port-of-Spain, Trinidad.
J R Coll Surg Edinb. 1991 Oct;36(5):309-11.
During the 2 years of 1987 and 1988, 74 patients with suspected malignant lung lesions underwent fine needle aspiration biopsy at the Bradford Royal Infirmary. Using a 20Fr needle, sufficient specimen (smear and clot) was obtained in 70 (95%) patients for histological examination. The indications for the procedure were: failure to make a diagnosis at bronchoscopy and bronchial lavage in 32 (43%) patients, peripherally located lesion in 28 (38%) patients, poor anaesthetic risk in 20 (27%) patients, negative bronchoscopy and mediastinostomy in five (7%) patients and three (4%) patients refused operative intervention. There were no deaths and complications were few. Seven patients developed pneumothorax, three of whom required intercostal drainage. Transient haemorrhage as shown by haemoptysis occurred in one patient and one patient complained of pleuritic chest pain. Of the 60 patients with malignant disease eventually proven, 50 were diagnosed correctly. The overall sensitivity and specificity of the test were 81 and 100% respectively based on histological and/or clinical outcome of the lung lesion. The test was cost-effective, diagnostic yield was high and complications were few. The use of fine needle aspiration biopsy as part of the management policy in peripheral lung lesions is realistic in a district general hospital.
在1987年和1988年这两年间，74例疑似肺部恶性病变的患者在布拉德福德皇家医院接受了细针穿刺活检。使用20号针，70例（95%）患者获取了足够的标本（涂片和凝块）用于组织学检查。该操作的适应证为：32例（43%）患者经支气管镜检查和支气管灌洗未能明确诊断；28例（38%）患者为周边性病变；20例（27%）患者麻醉风险高；5例（7%）患者支气管镜检查及纵隔切开术结果为阴性；3例（4%）患者拒绝手术干预。无死亡病例，并发症较少。7例患者发生气胸，其中3例需要肋间引流。1例患者出现咯血表现的短暂出血，1例患者主诉有胸膜炎性胸痛。最终证实60例患有恶性疾病，其中50例诊断正确。基于肺部病变的组织学和/或临床结果，该检查的总体敏感性和特异性分别为81%和100%。该检查具有成本效益，诊断率高且并发症少。在地区综合医院，将细针穿刺活检用作周边肺部病变管理策略的一部分是切实可行的。
