Ng Y L, Patsios D, Roberts H, Walsham A, Paul N S, Chung T, Herman S, Weisbrod G
Joint Department of Medical Imaging, Thoracic Division, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada.
Clin Radiol. 2008 Mar;63(3):272-7. doi: 10.1016/j.crad.2007.09.003. Epub 2007 Nov 19.
To determine the value of computed tomography (CT)-guided fine-needle aspiration biopsy (FNAB) of small pulmonary nodules measuring 10 mm or less.
CT-guided FNABs of 55 nodules, measuring 10mm or less, were performed between January 2003 and February 2006. A coaxial technique was used, with an outer 19 G Bard Truguide needle and inner 22 G disposable Greene biopsy needle. Adequacy of specimens was assessed on-site by a cytotechnologist. The sizes of the nodules, distance from pleura, number of pleural punctures and aspirates, complications encountered, cytological diagnosis, and outcome were recorded.
The mean nodule diameter was 9 mm (range 5-10 mm). The average distance from the costal pleura was 31 mm (range 0-88 mm). In 50 of the 55 FNABs, the pleura was crossed once. An average of four aspirates was performed per case. Twenty-five FNABs (45.5%) were adequate for diagnosis (24 malignant and one tuberculosis). In 11 cases, where no definite diagnosis was made following FNAB, the outcome was not affected. In 10 cases, samples were insufficient for diagnosis and the nodules were subsequently diagnosed as malignant. Eight cases were excluded in the final analysis as follow-up details were unavailable. The sensitivity for malignancy and overall accuracy were 67.7 and 78.8%, respectively. Pneumothorax occurred in 29 (52.7%) patients, with five (9.1%) requiring thoracostomy tubes.
CT-guided FNAB is a useful tool in the diagnosis and management of small pulmonary nodules, despite the lower diagnostic accuracy and higher complication rate than those of larger pulmonary lesions.
确定计算机断层扫描（CT）引导下对直径10毫米及以下的小肺结节进行细针穿刺活检（FNAB）的价值。
2003年1月至2006年2月期间，对55个直径10毫米及以下的结节进行了CT引导下的FNAB。采用同轴技术，使用外径19G的巴德Truguide针和内径22G的一次性格林活检针。标本的充足性由细胞技术人员在现场评估。记录结节大小、距胸膜的距离、胸膜穿刺次数和抽吸次数、遇到的并发症、细胞学诊断及结果。
结节平均直径为9毫米（范围5 - 10毫米）。距肋胸膜的平均距离为31毫米（范围0 - 88毫米）。55例FNAB中有50例仅穿刺胸膜一次。每例平均进行4次抽吸。25例FNAB（45.5%）标本充足可用于诊断（24例为恶性，1例为结核）。11例FNAB后未明确诊断的病例，其结果未受影响。10例样本不足以诊断，随后这些结节被诊断为恶性。8例因无法获得随访细节而在最终分析中被排除。恶性肿瘤的敏感性和总体准确率分别为67.7%和78.8%。29例（52.7%）患者发生气胸，其中5例（9.1%）需要放置胸腔引流管。
CT引导下的FNAB是诊断和处理小肺结节的有用工具，尽管其诊断准确性低于较大肺病变且并发症发生率较高。
