From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195.
Radiology. 2018 Mar;286(3):1052-1061. doi: 10.1148/radiol.2017170893. Epub 2017 Nov 20.
Purpose To compare the diagnostic yield and complication rates of electromagnetic navigational bronchoscopic (ENB)-guided and computed tomography (CT)-guided percutaneous tissue sampling of lung nodules. Materials and Methods Retrospectively identified were 149 patients sampled percutaneously with CT guidance and 146 patients who underwent ENB with transbronchial biopsy of a lung lesion between 2013 and 2015. Clinical data, incidence of complications, and nodule pathologic analyses were assessed through electronic medical record review. Lung nodule characteristics were reviewed through direct image analysis. Molecular marker studies and pathologic analyses from surgical excision were reviewed when available. Multiple-variable logistic regression models were built to compare the diagnostic yield and complication rates for each method and for different patient and disease characteristics. Results CT-guided sampling was more likely to be diagnostic than ENB-guided biopsy (86.0% [129 of 150] vs 66.0% [99 of 150], respectively), and this difference remained significant even after adjustments were made for patient and nodule characteristics (P < .001). Age, American Society of Anesthesiologists class, emphysema grade, nodule size, and distance from pleura were not significant predictors of increased diagnostic yield. Intraprocedural time for physicians was significantly lower with CT-guided sampling (P < .001). Similar yield for molecular analyses was noted with the two approaches (ENB-guided sampling, 88.9% [32 of 36]; CT-guided sampling, 82.0% [41 of 50]). The two groups had similar rates of major complications (symptomatic hemorrhage, P > .999; pneumothorax requiring chest tube and/or admission, P = .417). Conclusion CT-guided transthoracic biopsy provided higher diagnostic yield in the assessment of peripheral pulmonary nodules than navigational bronchoscopy with a similar rate of clinically relevant complications. RSNA, 2017 Online supplemental material is available for this article.
目的 比较电磁导航支气管镜（ENB）引导与计算机断层扫描（CT）引导经皮肺结节穿刺活检的诊断率和并发症发生率。
材料与方法 回顾性分析了 2013 年至 2015 年间经 CT 引导穿刺活检的 149 例患者和经支气管镜 ENB 引导下活检的 146 例患者的临床资料、并发症发生率和结节病理分析。通过电子病历回顾评估肺结节特征。当有分子标志物研究和手术切除的病理分析时，也对其进行评估。建立多变量逻辑回归模型，比较两种方法以及不同患者和疾病特征的诊断率和并发症发生率。
结果 CT 引导下采样的诊断率明显高于 ENB 引导下活检（分别为 86.0%[129/150]和 66.0%[99/150]），即使在调整了患者和结节特征后，这种差异仍然具有统计学意义（P <.001）。年龄、美国麻醉医师协会分级、肺气肿分级、结节大小和胸膜距离均不是诊断率增加的显著预测因素。医师的术中时间明显更短（P <.001）。两种方法的分子分析的检出率相似（ENB 引导下采样 88.9%[32/36]；CT 引导下采样 82.0%[41/50]）。两组主要并发症发生率相似（症状性出血，P >.999；需要胸腔引流管和/或住院的气胸，P =.417）。
结论 CT 引导下经胸穿刺活检在评估周围性肺结节方面的诊断率高于导航支气管镜，且具有相似的临床相关并发症发生率。
RSNA，2017 在线补充材料可在本文中获取。
