Department of Radiology, Chung-Ang University Medical Center, Chung-Ang University College of Medicine, Seoul Republic of Korea.
Br J Radiol. 2012 Jun;85(1014):e217-22. doi: 10.1259/bjr/64727750. Epub 2011 Oct 18.
The purpose of our study was to evaluate the diagnostic accuracy of transthoracic fine-needle aspiration biopsy (TFNAB) using a C-arm cone-beam CT (CBCT) system and to assess risk factors for immediate post-procedural complications in patients with lung lesions.
From October 2007 to April 2009, 94 TFNAB procedures using a C-arm system were studied in 91 patients with pulmonary lesions a chest CT scans. We retrospectively reviewed the patients' radiological and histopathological findings. We evaluated the lesion size, lesion abutted to pleura and presence or absence of emphysema along the needle path, lesion depth, visibility of target lesion and patient's position. Pneumothorax and pulmonary haemorrhage were assessed after TFNAB. Overall diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were analysed.
In 94 TFNAB procedures, 58 lesions were malignant and 36 were benign. The sensitivity, specificity, PPV, NPV and overall diagnostic accuracy rate of TFNAB were 93.1%, 100%, 100%, 90% and 97.9%, respectively. Pneumothorax was developed in 24 procedures. None of the parameters showed significant impact on the frequency of the pneumothorax. Overall haemorrhage occurred in 43 procedures. The incidence of overall haemorrhage was higher in patients with smaller lesions, longer pleural distance and pleural abutted lesions (p<0.05). Differences in visibility at projection radiographs were statistically significant between patients with or without perilesional haemorrhage (p<0.05).
Transthoracic fine-needle aspiration biopsy using a C-arm CBCT system is feasible for imaging guidance of lung lesion and early detection of the procedural-related complications.
本研究旨在评估使用 C 臂锥形束 CT（CBCT）系统进行经胸细针抽吸活检（TFNAB）的诊断准确性，并评估肺部病变患者即刻术后并发症的危险因素。
2007 年 10 月至 2009 年 4 月，对 91 例肺部病变患者的 94 例 TFNAB 进行了回顾性分析，这些患者均行胸部 CT 扫描。我们回顾性地分析了患者的影像学和组织病理学检查结果。评估了病变大小、病变与胸膜毗邻情况、针道是否存在肺气肿、病变深度、目标病变的可及性以及患者的体位。在 TFNAB 后评估气胸和肺出血。分析了总诊断准确率、敏感度、特异度、阳性预测值（PPV）和阴性预测值（NPV）。
在 94 例 TFNAB 中，58 例为恶性病变，36 例为良性病变。TFNAB 的敏感度、特异度、PPV、NPV 和总诊断准确率分别为 93.1%、100%、100%、90%和 97.9%。24 例发生气胸。各参数均未显示与气胸发生频率有显著相关性。43 例发生整体出血。病变较小、胸膜距离较长、胸膜毗邻病变的患者总体出血发生率较高（p<0.05）。在投影射线照片上的可见度差异在有或无周围出血的患者之间有统计学意义（p<0.05）。
使用 C 臂 CBCT 系统进行经胸细针抽吸活检对于肺部病变的影像学引导和早期发现手术相关并发症是可行的。
