Servizio di Radiologia, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy.
Radiology. 2013 Mar;266(3):930-5. doi: 10.1148/radiol.12112077. Epub 2012 Nov 30.
To retrospectively compare the outcome of computed tomography (CT) and ultrasonography (US) guidance when sampling a consecutive series of peripheral lung or pleural lesions.
Institutional review board approval was obtained, and the informed consent requirement was waived. From January 2000 to August 2011, 711 thoracic biopsies were performed at two institutions. Among these, 273 lesions in 273 patients (115 men, 158 women; mean age, 65 years ± 11 [standard deviation]; 86 pleural lesions; 187 pulmonary lesions) had pleural origin or were peripherally located in the lung with a small amount of pleural contact. These lesions were sampled with either CT (170 patients; mean age, 64 years ± 12; 55 pleural lesions, 115 peripheral pulmonary lesions) or US (103 patients; mean age, 67 years ± 10; 31 pleural lesions, 72 peripheral pulmonary lesions) guidance by using an 18-gauge modified Menghini needle. Procedure duration, postprocedural pneumothorax or hemorrhage, and sample adequacy were recorded. Fisher exact test, log-rank test, and Mann-Whitney U test were performed.
No significant difference was found for patient age (P = .741), sex (P = .900), lesion size (P = .206), or lesion origin (P = .788). Median time was 556 seconds for CT-guided biopsy (25th percentile, 408 seconds; 75th percentile, 704 seconds) and 321 seconds for US-guided biopsy (25th percentile, 157 seconds; 75th percentile, 485 seconds) (P < .001). Postprocedural pneumothorax was observed in 25 of 170 (14.7%) CT-guided procedures and in six of 103 (5.8%) US-guided procedures (P = .025); hemorrhage occurred in two of 170 (1.2%) CT-guided procedures and in one of 103 (1.0%) US-guided procedures (P = .875). Technical success was achieved in 100 of 103 US-guided procedures (97.1%) and in 164 of 170 CT-guided procedures (96.5%) (P = .999).
With pleural or peripheral lung lesions, US guidance is comparable to CT guidance in terms of sample accuracy, while allowing for a significant reduction in procedure time and postprocedural pneumothorax and being free from ionizing radiation.
回顾性比较连续系列肺外周或胸膜病变行 CT 和超声引导下穿刺活检的结果。
本研究获得了机构审查委员会的批准，并放弃了知情同意书的要求。2000 年 1 月至 2011 年 8 月，在两个机构共进行了 711 例胸部活检。其中，273 例患者的 273 个病变（115 例男性，158 例女性；平均年龄 65 岁±11[标准差]；86 个胸膜病变；187 个肺外周病变）具有胸膜起源或少量胸膜接触的肺外周位置。这些病变采用 18 号改良 Menghini 针分别进行 CT（170 例患者；平均年龄 64 岁±12；55 个胸膜病变，115 个肺外周病变）或 US（103 例患者；平均年龄 67 岁±10；31 个胸膜病变，72 个肺外周病变）引导下进行取样。记录了操作时间、术后气胸或出血以及样本充足性。采用 Fisher 确切检验、对数秩检验和 Mann-Whitney U 检验进行分析。
患者年龄（P =.741）、性别（P =.900）、病变大小（P =.206）或病变起源（P =.788）无显著差异。CT 引导活检的中位时间为 556 秒（25 百分位数，408 秒；75 百分位数，704 秒），US 引导活检的中位时间为 321 秒（25 百分位数，157 秒；75 百分位数，485 秒）（P <.001）。170 例 CT 引导活检中有 25 例（14.7%）发生术后气胸，103 例 US 引导活检中有 6 例（5.8%）发生术后气胸（P =.025）；170 例 CT 引导活检中有 2 例（1.2%）发生术后出血，103 例 US 引导活检中有 1 例（1.0%）发生术后出血（P =.875）。103 例 US 引导活检中，100 例（97.1%）操作技术成功，170 例 CT 引导活检中，164 例（96.5%）操作技术成功（P =.999）。
对于胸膜或肺外周病变，与 CT 引导相比，US 引导在样本准确性方面具有可比性，同时可显著缩短操作时间和术后气胸的发生，并避免了电离辐射。
