肺部肿块：锥形束 CT 引导下使用针规划软件进行经皮肺活检的初步结果。

Pulmonary masses: initial results of cone-beam CT guidance with needle planning software for percutaneous lung biopsy.

机构信息

Department of Radiology, St. Antonius Hospital, P.O. Box 2500, 3430, EM, EM Nieuwegein, The Netherlands.

出版信息

Cardiovasc Intervent Radiol. 2012 Dec;35(6):1414-21. doi: 10.1007/s00270-011-0302-z. Epub 2011 Dec 7.

DOI:10.1007/s00270-011-0302-z

PMID:22146973

Abstract

PURPOSE

To evaluate the outcome of percutaneous lung biopsy (PLB) findings using cone-beam computed tomographic (CT) guidance (CBCT guidance) and compared to conventional biopsy guidance techniques.

METHODS

CBCT guidance is a stereotactic technique for needle interventions, combining 3D soft-tissue cone-beam CT, needle planning software, and real-time fluoroscopy. Between March 2007 and August 2010, we performed 84 Tru-Cut PLBs, where bronchoscopy did not provide histopathologic diagnosis. Mean patient age was 64.6 (range 24-85) years; 57 patients were men, and 25 were women. Records were prospectively collected for calculating sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. We also registered fluoroscopy time, room time, interventional time, dose-area product (DAP), and complications. Procedures were divided into subgroups (e.g., location, size, operator).

RESULTS

Mean lesion diameter was 32.5 (range 3.0-93.0) mm, and the mean number of samples per biopsy procedure was 3.2 (range 1-7). Mean fluoroscopy time was 161 (range 104-551) s, room time was 34 (range 15-79) min, mean DAP value was 25.9 (range 3.9-80.5) Gy·cm(-2), and interventional time was 18 (range 5-65) min. Of 84 lesions, 70 were malignant (83.3%) and 14 were benign (16.7%). Seven (8.3%) of the biopsy samples were nondiagnostic. All nondiagnostic biopsied lesions proved to be malignant during surgical resection. The outcome for sensitivity, specificity, positive predictive value, negative predictive value, and accuracy was 90% (95% confidence interval [CI] 86-96), 100% (95% CI 82-100), 100% (95% CI 96-100), 66.7% (95% CI 55-83), and 91.7% (95% CI 86-96), respectively. Sixteen patients (19%) had minor and 2 (2.4%) had major complications.

CONCLUSION

CBCT guidance is an effective method for PLB, with results comparable to CT/CT fluoroscopy guidance.

摘要

目的

评估使用锥形束 CT（CBCT）引导进行经皮肺活检（PLB）的结果，并与传统活检引导技术进行比较。

方法

CBCT 引导是一种用于针介入的立体定向技术，结合了 3D 软组织锥形束 CT、针规划软件和实时透视。在 2007 年 3 月至 2010 年 8 月期间，我们对 84 例支气管镜检查未提供组织病理学诊断的 Tru-Cut PLB 进行了操作。患者平均年龄为 64.6（24-85）岁；57 名患者为男性，25 名患者为女性。前瞻性收集记录以计算敏感性、特异性、阳性预测值、阴性预测值和准确性。我们还记录了透视时间、房间时间、介入时间、剂量面积乘积（DAP）和并发症。程序分为亚组（例如，位置、大小、操作者）。

结果

平均病变直径为 32.5（3.0-93.0）mm，每次活检的平均样本数为 3.2（1-7）个。平均透视时间为 161（104-551）s，房间时间为 34（15-79）min，平均 DAP 值为 25.9（3.9-80.5）Gy·cm(-2)，介入时间为 18（5-65）min。84 个病灶中，70 个为恶性（83.3%），14 个为良性（16.7%）。7（8.3%）个活检样本无法诊断。所有无法诊断的活检病变在手术切除时均证实为恶性。敏感性、特异性、阳性预测值、阴性预测值和准确性的结果分别为 90%（95%CI 86-96）、100%（95%CI 82-100）、100%（95%CI 96-100）、66.7%（95%CI 55-83）和 91.7%（95%CI 86-96）。16 名患者（19%）出现轻微并发症，2 名患者（2.4%）出现严重并发症。