Nakahara Yasuharu, Mochiduki Yoshiro, Miyamoto Yoshihiro
Department of Respiratory Medicine, National Hospital Organization, Himeji Medical Center.
Intern Med. 2007;46(14):1089-94. doi: 10.2169/internalmedicine.46.0020. Epub 2007 Jul 17.
It is difficult to obtain sufficient material from pulmonary thin-walled cavitary lesions filled with air by conventional percutaneous aspiration biopsy in order to make a diagnosis. In these cases, we performed percutaneous needle washing (PNW) and ascertained the diagnostic significance of this method.
PNW was performed on 27 patients with a pulmonary thin-walled cavitary lesion whose diagnosis could not be made by sputum and bronchoscopic examinations. Before centesis, the depth of the lesion was measured on CT scan. After the 22-gauge needle was inserted under X-ray fluoroscopic guidance, normal saline was injected into the cavity and aspirated. The aspirated material was examined cytologically and microbiologically. The procedure was carried out during one 30-second breath-holding.
Upon performing PNW on 27 patients, malignant cells were detected in 10 patients and a bacterial or fungal pathogen was detected in 9 other patients [Aspergillus (4), Mycobacterium (3), Staphylococcus (1), Streptococcus (1)]. The diagnoses of 16 of the 17 patients who were negative for malignant cells on PNW, were ascertained as benign disease during their clinical course including 3 patients who were diagnosed as (or suspected of) having infectious disease clinically, while the diagnosis of one case was unknown. Therefore, the diagnostic sensitivity of PNW for malignant diseases was 91% (10/11), while that for infectious diseases was 69% (9/13). Mild pneumothorax was the only complication of PNW (2 cases).
PNW may be an appropriate diagnostic procedure for pulmonary thin-walled cavitary lesions whose diagnosis can not be established by other techniques.
对于充满空气的肺薄壁空洞性病变，通过传统经皮穿刺抽吸活检很难获取足够的材料来进行诊断。在这些病例中，我们进行了经皮针冲洗（PNW）并确定了该方法的诊断意义。
对27例经痰液和支气管镜检查无法确诊的肺薄壁空洞性病变患者进行PNW。穿刺前，在CT扫描上测量病变深度。在X线透视引导下插入22号针后，向空洞内注入生理盐水并抽吸。对抽吸物进行细胞学和微生物学检查。该操作在一次30秒屏气期间进行。
对27例患者进行PNW后，10例患者检测到恶性细胞，另外9例患者检测到细菌或真菌病原体[曲霉菌（4例）、分枝杆菌（3例）、葡萄球菌（1例）、链球菌（1例）]。PNW检查恶性细胞阴性的17例患者中，有16例在临床过程中被确定为良性疾病，其中3例临床诊断为（或怀疑）患有传染病，而1例诊断不明。因此，PNW对恶性疾病的诊断敏感性为91%（10/11），对传染病的诊断敏感性为69%（9/13）。轻度气胸是PNW的唯一并发症（2例）。
对于其他技术无法确诊的肺薄壁空洞性病变，PNW可能是一种合适的诊断方法。
