Rebonato Alberto, Maiettini Daniele, Andolfi Marco, Fischer Matthias J, Vannucci Jacopo, Metro Giulio, Basile Antonio, Rossi Michele, Duranti Michele
Radiology Unit, Department of Surgical and Biomedical Science, Santa Maria della Misericordia University Hospital, Perugia University, Sant'Andrea delle Fratte, 06132, Perugia, Italy.
Department of Thoracic Surgery, S. Maria della Misericordia Hospital, University of Perugia Medical School, Sant'Andrea delle Fratte, 06132, Perugia, Italy.
Cardiovasc Intervent Radiol. 2018 Feb;41(2):284-290. doi: 10.1007/s00270-017-1768-0. Epub 2017 Aug 14.
CT-guided percutaneous transthoracic lung needle biopsy (PLB) is an effective procedure for obtaining cyto-histological diagnoses of peripheral lesions. However, upper postero-lateral lung nodules (UPLN) may be difficult to reach using a standard intercostal either anterior or lateral approach or when the nodule is just behind a rib or scapula. We evaluated the feasibility and effectiveness of trans-scapular approach (tPLB) in these patients using large-core needles.
We retrospectively collected the data of 11 consecutive patients (mean age 74.6 years, SD 5.9) among those scheduled to undergo CT-guided PLB over the period February 2015 to February 2017. In these patients, the presence of a UPLN required a tPLB using a co-axial technique and large full-core needles (15G for the scapular piercing and 18-19G for tissue sampling). All patients were assessed by telephone at 24 h, 78 h and at an office visit at 30 days after the procedure to evaluate post-procedural pain (VAS score) and shoulder mobility.
Ten of the eleven samples were diagnostic. No major complications were encountered. Three patients developed a pneumothorax, but none required pleural drainage. All the patients confirmed the absence of pain at 24-72 h and 30 days, reporting a VAS score less than 1, without any shoulder mobility limitation.
tPLB seems to be an effective and feasible procedure, accompanied by a low risk of pneumothorax in UPLN cases.
CT引导下经皮经胸肺穿刺活检（PLB）是获取周围性病变细胞组织学诊断的有效方法。然而，使用标准的前侧或外侧肋间入路可能难以到达肺上后外侧结节（UPLN），或者当结节恰好在肋骨或肩胛骨后方时也难以穿刺。我们评估了使用粗针经肩胛入路（tPLB）对这些患者的可行性和有效性。
我们回顾性收集了2015年2月至2017年2月期间计划接受CT引导下PLB的11例连续患者（平均年龄74.6岁，标准差5.9）的数据。在这些患者中，UPLN的存在需要采用同轴技术和粗的全芯针进行tPLB（15G用于穿刺肩胛，18 - 19G用于组织取样）。在术后24小时、78小时通过电话以及术后30天门诊就诊时对所有患者进行评估，以评估术后疼痛（视觉模拟评分法[VAS]评分）和肩部活动度。
11个样本中有10个具有诊断价值。未遇到重大并发症。3例患者发生气胸，但均无需胸腔引流。所有患者在24 - 72小时和30天时均确认无疼痛，VAS评分小于1，且肩部活动度无任何受限。
tPLB似乎是一种有效且可行的方法，在UPLN病例中气胸风险较低。
