Radiology Department, Faculty of Medicine, Ain Shams University, Egypt Abbassyia square, Cairo, Egypt.
Eur J Radiol. 2012 Oct;81(10):2907-12. doi: 10.1016/j.ejrad.2011.11.008. Epub 2011 Dec 7.
To report our experience in CT guided extrapleural paravertebral subcarinal lymph biopsy using a thin 25 gauge (25 G) thin needle without the need of injection of saline to widen the mediastinum.
Biopsy was performed using a 25 G needle which was advanced lateral to the vertebral body between the endothoracic fascia and the parietal pleura to gain access to subcarinal lymph nodes. One hundred and forty one patients were included in the study (74 females, 57 males). No artificial widening of the mediastinum using saline injection was required. The study was performed in the presence of a cytopathologist; sensitivity and specificity rates were calculated. Complications were documented for each case especially for pneumothorax and haemorrhage.
Cytopathological diagnosis was reached in all cases. All re-aspirations were done in the same session to reach a primary diagnosis at the time of the biopsy. Imunophenotyping study was done in 94 cases to confirm the primary diagnosis and to classify the malignant lesions. No pneumothorax was encountered. Small haematomas were noted in 5 cases (3.5%). Cytopathology showed a sensitivity of 97.2% and specificity of 100%. By adding immunophenotyping a 100% sensitivity and specificity was achieved.
Fine needle aspiration cytology (FNAC) using a 25 gauge needle for subcarinal lymph nodes via a percutaneous extrapleural paravertebral CT guided approach is a safe, minimally invasive, and tolerable procedure yielding a high sensitivity and specificity rates without the need of artificial widening.
报告我们在 CT 引导下经胸膜外椎旁肋脊区行细 25 号（25G）针经皮穿刺活检的经验，该方法无需注射生理盐水以扩大纵隔。
采用 25G 穿刺针，在胸内筋膜和壁层胸膜之间向椎体外侧进针，以获得肋脊区淋巴结。本研究共纳入 141 例患者（74 例女性，57 例男性）。无需使用生理盐水进行纵隔人工扩张。研究过程中有细胞病理学家在场，计算了敏感性和特异性。记录了每个病例的并发症，特别是气胸和出血。
所有病例均获得细胞学诊断。所有再次抽吸均在同一时间进行，以便在活检时获得原发性诊断。94 例进行免疫表型研究以确认原发性诊断并对恶性病变进行分类。未发生气胸。5 例（3.5%）出现小血肿。细胞病理学的敏感性为 97.2%，特异性为 100%。通过添加免疫表型，敏感性和特异性均达到 100%。
经 CT 引导经胸膜外椎旁入路用 25G 针行细针抽吸细胞学（FNAC）检查，可安全、微创、耐受，获得较高的敏感性和特异性，无需人工扩大。
