Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
AJR Am J Roentgenol. 2012 Sep;199(3):W322-30. doi: 10.2214/AJR.11.7576.
The purpose of this study is to retrospectively evaluate the diagnostic accuracy and complications of C-arm cone-beam CT (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB) for small (≤ 20 mm) lung nodules and their possible influencing factors.
From March 2009 to July 2010, 161 consecutive patients (77 men and 84 women; mean [± SD] age, 61 ± 11.8 years; range, 29-85 years) with 173 small (≤ 20 mm) lung nodules underwent CBCT-guided PTNB performed by an experienced chest radiologist in a tertiary referral hospital. The diagnostic accuracy, sensitivity, specificity, and complication rates were statistically evaluated, and influencing factors were assessed using univariate and subsequent multivariate analysis.
Of 173 nodules (mean size, 15 ± 3.7 mm), 94 (54.3%) were diagnosed as malignant, 69 (39.9%) as benign, and 10 (5.8%) as indeterminate. On PTNB, 160 nodules were correctly diagnosed and three were false-negatives. Diagnostic accuracy, sensitivity, and specificity were 98.2%, 96.8%, and 100%, respectively. No factors significantly decreased diagnostic accuracy. As for complications, pneumothorax, hemoptysis, and chest pain occurred in 55 (31.8%), 25 (14.5%), and two (1.2%) patients, respectively. Multivariate analysis revealed that the presence of emphysema along the needle pathway was a significant risk factor (odds ratio [OR], 10.11), and the occurrence of hemoptysis was a significant protective factor (OR, 0.28) against pneumothorax. Ground-glass nodules were found to be a significant independent risk factor for hemoptysis (OR, 5.10).
C-arm CBCT-guided PTNB is highly accurate for small lung nodules, and the diagnostic accuracy does not significantly decrease even in technically challenging conditions.
本研究旨在回顾性评估 C 臂锥形束 CT（CBCT）引导经皮经胸穿刺活检（PTNB）对≤20mm 肺小结节的诊断准确性和并发症，并分析其可能的影响因素。
2009 年 3 月至 2010 年 7 月，在一家三级转诊医院，由一位经验丰富的胸部放射科医生对 161 例连续患者（77 例男性和 84 例女性；平均[±SD]年龄 61±11.8 岁；范围 29-85 岁）的 173 个小（≤20mm）肺结节进行了 CBCT 引导的 PTNB。使用单变量和随后的多变量分析评估诊断准确性、灵敏度、特异性和并发症发生率，并评估影响因素。
173 个结节（平均大小 15±3.7mm）中，94 个（54.3%）诊断为恶性，69 个（39.9%）为良性，10 个（5.8%）为不确定。在 PTNB 中，160 个结节得到正确诊断，3 个为假阴性。诊断准确性、灵敏度和特异性分别为 98.2%、96.8%和 100%。没有因素显著降低诊断准确性。并发症方面，55 例（31.8%）发生气胸，25 例（14.5%）发生咯血，2 例（1.2%）发生胸痛。多变量分析显示，针道伴有肺气肿是气胸的显著危险因素（比值比[OR]，10.11），而咯血是气胸的显著保护因素（OR，0.28）。磨玻璃结节是咯血的显著独立危险因素（OR，5.10）。
C 臂 CBCT 引导的 PTNB 对小肺结节具有高度准确性，即使在技术挑战性较大的情况下，诊断准确性也不会显著降低。
