McSweeney Sean E, O'Regan Kevin N, Mc Laughlin Patrick D, Crush Lee, Maher Michael M
Department of Radiology, Cork University Hospital and University College Cork, Cork, Ireland.
Open Respir Med J. 2012;6:82-8. doi: 10.2174/1874306401206010082. Epub 2012 Sep 6.
Percutanous needle biopsy of the lung (PNBL), under image guidance, has established itself as a safe and effective minimally-invasive method of obtaining a tissue diagnosis of pulmonary lesions, for selected patients with suspected pathologic processes. The purpose of this study was to evaluate the diagnostic yield and safety of percutaneous core biopsy of the lung (PCBL) without Fine Needle Aspiration Biopsy (FNAB), with specific attention to potential risk factors that may predict post-biopsy pneumothorax.
A retrospective analysis of 75 consecutive PCBL procedures between January 2006 to March 2008 involving 72 patients with a documented pulmonary nodule or mass lesion on CT scan of Thorax. The study population included 38 males (52.8%) and 34 females (47.2%) aged 20-85 years (mean age 63.6 years). A co-axial cutting system with a 19-gauge outer needle and a 20-gauge inner automated cutting needle (Temno, Allegiance Healthcare Corporation, Ohio, USA) was used in all patients.
Lesions varied in size from 0.7cm to 10.7cm (mean maximum trans-axial diameter 3.1cm). The mean number of core biopsy samples obtained was 3.1 (range 1-5). Of the 75 PCBL procedures, 71 yielded specimens adequate for histopathologic evaluation, consistent with a technical success rate of 95%. Malignancy was detected in 48 specimens (64%) and benign diagnoses were identified in 23 specimens (31%). As mentioned, 4 specimens (5%) were nondiagnostic. The most common biopsy-induced complication was pneumothorax, occurring in 15 patients (20%), with 4 (5.3%) requiring thoracostomy tube placement.
PCBL without FNAB, under CT fluoroscopy guidance, has an excellent diagnostic accuracy in obtaining a conclusive histologic diagnosis of thoracic lesions and is comparable to FNAB in terms of safety and rates of occurence of complications.
在影像引导下，经皮肺穿刺活检（PNBL）已成为一种安全有效的微创方法，可为选定的疑似病理过程患者获取肺部病变的组织诊断。本研究的目的是评估不进行细针穿刺抽吸活检（FNAB）的经皮肺芯针活检（PCBL）的诊断率和安全性，特别关注可能预测活检后气胸的潜在危险因素。
对2006年1月至2008年3月期间连续进行的75例PCBL手术进行回顾性分析，这些手术涉及72例经胸部CT扫描记录有肺结节或肿块病变的患者。研究人群包括38名男性（52.8%）和34名女性（47.2%），年龄在20 - 85岁之间（平均年龄63.6岁）。所有患者均使用带有19号外针和20号内自动切割针的同轴切割系统（Temno，美国俄亥俄州忠诚医疗保健公司）。
病变大小从0.7厘米至10.7厘米不等（平均最大横轴直径3.1厘米）。获得的芯针活检样本平均数量为3.1个（范围为1 - 5个）。在75例PCBL手术中，71例获得了足以进行组织病理学评估的标本，技术成功率为95%。48例标本（64%）检测到恶性肿瘤，23例标本（31%）确定为良性诊断。如前所述，4例标本（5%）无法诊断。最常见的活检引起的并发症是气胸，15例患者（20%）发生气胸，其中4例（5.3%）需要放置胸腔引流管。
在CT透视引导下，不进行FNAB的PCBL在获得胸部病变的确切组织学诊断方面具有出色的诊断准确性，在安全性和并发症发生率方面与FNAB相当。
