计算机断层扫描引导经皮肺门淋巴结穿刺活检的准确性和敏感性。

Accuracy and sensitivity of computed tomography-guided percutaneous needle biopsy of pulmonary hilar lymph nodes.

机构信息

Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.

出版信息

Cancer. 2010 Apr 15;116(8):1974-80. doi: 10.1002/cncr.24968.

DOI:10.1002/cncr.24968

PMID:20151422

Abstract

BACKGROUND

Because of their proximity to the pulmonary artery or vein, hilar lymph nodes are routinely biopsied with endobronchial or endoscopic ultrasonography (EUS)-guided fine-needle aspiration biopsy (FNAB). Computed tomography (CT)-guided percutaneous needle biopsy (PNB) allows the operator to acquire a larger core needle biopsy (CNB) when initial samples are inconclusive, when the suspected disease is not optimally diagnosed with FNAB, or when biomarkers are required. The purpose of this study was to retrospectively evaluate the sensitivity and accuracy of CT-guided PNB in patients with hilar adenopathy.

METHODS

The authors identified 80 patients who underwent 81 CT-guided PNBs of pulmonary hilar lesions from October 2002 through December 2006 and retrospectively reviewed their medical and imaging records. The PNB sensitivity and accuracy were calculated in each case, and each case was reviewed for complications, including pneumothorax and subsequent thoracostomy tube insertion.

RESULTS

PNB included FNAB and CNB in 81 (100%) and 14 (17%) procedures, respectively. Data on 69 PNB specimens (67 FNAB specimens and 13 CNB specimens) were available for statistical analysis. Overall, PNB had a sensitivity of 91.4% (95% confidence interval [CI], 81.0%-97.1%) and an accuracy rate of 92.8% (95% CI, 83.9%-97.1%). Pneumothoraxes occurred in 39 patients (48%), 26 (32%) of whom required thoracostomy tube insertion.

CONCLUSIONS

CT-guided PNB of pulmonary hilar lesions has high sensitivity and accuracy and represents a viable alternative for endobronchial ultrasound- or EUS-guided FNAB when larger biopsy samples are required for diagnosis or biomarker analysis. However, the procedure can result in high rates of pneumothorax.

摘要

背景

由于靠近肺动脉或静脉，肺门淋巴结通常通过支气管内或内镜超声引导下的细针抽吸活检（FNAB）进行活检。当初始样本不确定时，当怀疑疾病不能通过 FNAB 进行最佳诊断时，或者需要生物标志物时，计算机断层扫描（CT）引导下的经皮针吸活检（PNB）允许操作者获取更大的核心针活检（CNB）。本研究的目的是回顾性评估 CT 引导下 PNB 在肺门淋巴结肿大患者中的敏感性和准确性。

方法

作者从 2002 年 10 月至 2006 年 12 月共确定了 80 例接受 81 例肺门病变 CT 引导下 PNB 的患者，并回顾性分析了他们的病历和影像学记录。计算了每种情况下的 PNB 敏感性和准确性，并对每种情况下的并发症进行了回顾，包括气胸和随后的胸腔引流管插入。

结果

PNB 包括 FNAB 和 CNB，分别有 81 例（100%）和 14 例（17%）。有 69 例 PNB 标本（67 例 FNAB 标本和 13 例 CNB 标本）的数据可用于统计分析。总体而言，PNB 的敏感性为 91.4%（95%置信区间[CI]，81.0%-97.1%），准确性为 92.8%（95% CI，83.9%-97.1%）。39 例患者（48%）发生气胸，其中 26 例（32%）需要胸腔引流管插入。