Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
J Thorac Oncol. 2012 Jan;7(1):143-50. doi: 10.1097/JTO.0b013e318233d7dd.
The aim of this study was to investigate the diagnostic value of percutaneous computed tomography (CT)-guided coaxial transthoracic needle biopsy (TNB) for small pulmonary lesions (≤ 3 cm) with persistent ground-glass opacity (GGO).
From January 2004 to February 2010, consecutive patients with persistent small GGO lesions (≤ 3 cm) who underwent CT-guided TNB were analyzed. The pathologic results of CT-guided TNB were compared with final diagnoses, and the GGO percentage on CT was correlated with the stromal invasion in surgical pathology.
We performed CT-guided TNB on 1612 patients during the study period. Among them, 55 patients had persistent small GGO lesions (size range 0.5-3.0 cm; 1.72 ± 0.73 cm), 47 were diagnosed with lung adenocarcinomas, and 8 with benign nonspecific lesions. Minor procedure-related complications occurred in 26 patients (47.3%) with small pneumothorax and 11 patients (20.0%) with self-limited mild hemoptysis. The final diagnoses of the 43 patients receiving lobectomy were invasive adenocarcinoma (n = 23), pure bronchioloalveolar carcinoma (n = 19), and mucosa-associated lymphoid tissue lymphoma (n = 1). The diagnostic accuracy was 93.0% (40/43) using CT-guided TNB. Pure GGO lesions had a higher incidence of pure bronchioloalveolar carcinoma than GGO-dominant lesions (70.0% versus 21.7%; p = 0.004). Compared with surgical pathology, stromal invasion was underestimated in 43.5% (10/23) of the TNB specimens, especially in pure GGO lesions (83%, 5/6). In logistic regression analysis, the GGO percentage correlated inversely with stromal tumor invasion (p = 0.0028).
CT-guided coaxial TNB is a safe and useful method for diagnosing small (≤ 3 cm) persistent GGO lesions. Stromal invasion may be underestimated by TNB in GGO lesions.
本研究旨在探讨经皮 CT 引导同轴经胸针吸活检（TNB）对持续磨玻璃影（GGO）≤3cm 的肺部小结节的诊断价值。
从 2004 年 1 月至 2010 年 2 月，对连续接受 CT 引导 TNB 的持续存在的小 GGO 病变（≤3cm）患者进行分析。将 CT 引导 TNB 的病理结果与最终诊断进行比较，并将 CT 上的 GGO 百分比与手术病理中的间质浸润进行相关性分析。
研究期间，我们对 1612 例患者进行了 CT 引导 TNB。其中，55 例患者有持续的小 GGO 病变（大小范围 0.5-3.0cm；1.72±0.73cm），47 例诊断为肺腺癌，8 例为良性非特异性病变。26 例（47.3%）出现少量气胸，11 例（20.0%）出现自限性轻度咯血等轻微的操作相关并发症。接受肺叶切除术的 43 例患者的最终诊断为浸润性腺癌（n=23）、单纯细支气管肺泡癌（n=19）和黏膜相关淋巴组织淋巴瘤（n=1）。使用 CT 引导 TNB 的诊断准确率为 93.0%（40/43）。纯 GGO 病变比 GGO 优势病变更易发生单纯细支气管肺泡癌（70.0%比 21.7%；p=0.004）。与手术病理相比，TNB 标本中间质浸润被低估了 43.5%（10/23），特别是在纯 GGO 病变中（83%，5/6）。在逻辑回归分析中，GGO 百分比与间质肿瘤浸润呈负相关（p=0.0028）。
CT 引导同轴 TNB 是诊断小（≤3cm）持续 GGO 病变的一种安全、有效的方法。TNB 可能低估 GGO 病变中的间质浸润。
