CT引导下经胸芯针穿刺活检术用于小肺病变：诊断性能及分子检测的充分性
CT-guided transthoracic core needle biopsy for small pulmonary lesions: diagnostic performance and adequacy for molecular testing.
作者信息
Tian Panwen, Wang Ye, Li Lei, Zhou Yongzhao, Luo Wenxin, Li Weimin
机构信息
Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu 610041, China.
Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
出版信息
J Thorac Dis. 2017 Feb;9(2):333-343. doi: 10.21037/jtd.2017.02.16.
BACKGROUND
Computed tomography (CT)-guided transthoracic needle biopsy is a well-established, minimally invasive diagnostic tool for pulmonary lesions. Few large studies have been conducted on the diagnostic performance and adequacy for molecular testing of transthoracic core needle biopsy (TCNB) for small pulmonary lesions.
METHODS
This study included CT-guided TCNB with 18-gauge cutting needles in 560 consecutive patients with small (≤3 cm) pulmonary lesions from January 2012 to January 2015. There were 323 males and 237 females, aged 51.8±12.7 years. The size of the pulmonary lesions was 1.8±0.6 cm. The sensitivity, specificity, accuracy and complications of the biopsies were investigated. The risk factors of diagnostic failure were assessed using univariate and multivariate analyses. The sample's adequacy for molecular testing of non-small cell lung cancer (NSCLC) was analyzed.
RESULTS
The overall sensitivity, specificity, and accuracy for diagnosis of malignancy were 92.0% (311/338), 98.6% (219/222), and 94.6% (530/560), respectively. The incidence of bleeding complications was 22.9% (128/560), and the incidence of pneumothorax was 10.4% (58/560). Logistic multivariate regression analysis showed that the independent risk factors for diagnostic failure were a lesion size ≤1 cm [odds ratio (OR), 3.95; P=0.007], lower lobe lesions (OR, 2.83; P=0.001), and pneumothorax (OR, 1.98; P=0.004). Genetic analysis was successfully performed on 95.45% (168/176) of specimens diagnosed as NSCLC. At least 96.8% of samples with two or more passes from a lesion were sufficient for molecular testing.
CONCLUSIONS
The diagnostic yield of small pulmonary lesions by CT-guided TCNB is high, and the procedure is relatively safe. A lesion size ≤1 cm, lower lobe lesions, and pneumothorax are independent risk factors for biopsy diagnostic failure. TCNB specimens could provide adequate tissues for molecular testing.
背景
计算机断层扫描（CT）引导下的经胸针吸活检是一种成熟的、用于肺部病变的微创诊断工具。关于经胸芯针活检（TCNB）对小肺部病变的诊断性能及分子检测充分性的大型研究较少。
方法
本研究纳入了2012年1月至2015年1月期间连续560例患有小（≤3 cm）肺部病变的患者，采用18号切割针进行CT引导下的TCNB。其中男性323例，女性237例，年龄51.8±12.7岁。肺部病变大小为1.8±0.6 cm。对活检的敏感性、特异性、准确性及并发症进行了研究。采用单因素和多因素分析评估诊断失败的危险因素。分析了样本对非小细胞肺癌（NSCLC）分子检测的充分性。
结果
诊断恶性肿瘤的总体敏感性、特异性和准确性分别为92.0%（311/338）、98.6%（219/222）和94.6%（530/560）。出血并发症发生率为22.9%（128/560），气胸发生率为10.4%（58/560）。Logistic多因素回归分析显示，诊断失败的独立危险因素为病变大小≤1 cm [比值比（OR），3.95；P = 0.007]、下叶病变（OR，2.83；P = 0.001）和气胸（OR，1.98；P = 0.004）。对诊断为NSCLC的标本，95.45%（168/176）成功进行了基因分析。来自病变部位两次或更多次穿刺的样本中，至少96.8%足以进行分子检测。
结论
CT引导下的TCNB对小肺部病变的诊断率高，且该操作相对安全。病变大小≤1 cm、下叶病变和气胸是活检诊断失败的独立危险因素。TCNB标本可为分子检测提供足够的组织。
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