Yazar Esra, Seçik Funda, Yıldız Pınar
Pulmonary Medicine Department, Yedikule Chest Disease Education and Training Hospital, Yedikule, İstanbul, Turkey.
Iran J Radiol. 2013 Jun;10(2):56-60. doi: 10.5812/iranjradiol.10031. Epub 2013 May 20.
Transthoracic fine needle aspiration biopsy is a well-established and safe technique for obtaining pulmonary tissue. However, there is very little data about repeating procedure.
We aimed to investigate whether repeating CT-guided transthoracic fine needle aspiration (TFNA) increases diagnostic yield and complication rate.
Patients underwent TFNA and the final diagnoses achieved were included in the study. Consequently, 316 TFNA procedures performed in 240 patients were investigated retrospectively. A diagnosis was not reached in the first TFNA in 64 patients, then they underwent repeated TFNA. The factors that affected the diagnostic yield and complication rate were recorded.
The final diagnoses of 199 (82.9%) patients were malignant and 41 patients were benign. One hundred seventy six patients underwent the TFNA procedure only once. Sixty-four patients underwent a second procedure, while 12 underwent a third one. The diagnosis rate in the first procedures (diagnosis obtained in 142 out of 240 patients) was 59%. With the repeated procedures, 30 other patients were diagnosed. The diagnosis rate increased to 72% (172 out of 240 patients) (P<0.001). Twenty-nine (9.2%) pneumothoraces in 26 patients were detected in 316 TFNA procedures. In the repeated TFNA group (64 patients) there were seven pneumothoraces (11%) in the first TFNA procedure and six pneumothoraces (9%) in the repeated TFNA procedures (P=0.41). In three patients, pneumothorax was detected in the first and repeated procedures. Pneumothorax was significantly associated with the maximum diameter of the lesion (P=0.003), distance to pleura (P=0.001), contact to the pleura (P=0.0001) and smoking history (pack/year) (P=0.04).
This study demonstrated that repeating the TFNA procedure in pulmonary lesions improves the diagnostic yield without an increase in the rate of pneumothorax.
经胸细针穿刺活检是一种成熟且安全的获取肺组织的技术。然而，关于重复该操作的数据非常少。
我们旨在研究重复CT引导下经胸细针穿刺抽吸术（TFNA）是否会提高诊断率和并发症发生率。
纳入接受TFNA且获得最终诊断的患者。因此，对240例患者进行的316次TFNA操作进行回顾性研究。64例患者首次TFNA未明确诊断，随后接受了重复TFNA。记录影响诊断率和并发症发生率的因素。
199例（82.9%）患者最终诊断为恶性，41例为良性。176例患者仅接受了一次TFNA操作。64例患者接受了第二次操作，12例接受了第三次操作。首次操作的诊断率（240例患者中有142例获得诊断）为59%。通过重复操作，又有30例患者得到诊断。诊断率提高到72%（240例患者中有172例）（P<0.001）。在316次TFNA操作中，26例患者发生了29次（9.2%）气胸。在重复TFNA组（64例患者）中，首次TFNA操作中有7次气胸（11%），重复TFNA操作中有6次气胸（9%）（P=0.41）。3例患者在首次和重复操作中均检测到气胸。气胸与病变最大直径（P=0.003）、距胸膜距离（P=0.001）、与胸膜接触情况（P=0.0001）及吸烟史（包/年）（P=0.04）显著相关。
本研究表明，对肺部病变重复进行TFNA操作可提高诊断率，且气胸发生率未增加。
