超声引导下经皮胸膜切割针活检：准确性及影响诊断率的因素
Ultrasound-guided pleural cutting needle biopsy: accuracy and factors influencing diagnostic yield.
作者信息
Zhang Yuxin, Tang Jiaxin, Zhou Xinghua, Zhou Dazhi, Wang Jinlin, Tang Qing
机构信息
Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
出版信息
J Thorac Dis. 2018 Jun;10(6):3244-3252. doi: 10.21037/jtd.2018.05.94.
BACKGROUND
The aim of this study was to retrospectively investigate the diagnostic accuracy of ultrasound-guided pleural cutting needle biopsy (US-guided PCNB) and the potential factors influencing diagnostic yield.
METHODS
From July 2014 to June 2016, a total of 147 percutaneous US-guided PCNBs in 144 patients were retrospectively reviewed. The final diagnosis was confirmed by histopathological analysis and follow-up. We calculated diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and divided all cases into group of correct diagnoses (true-positive and true-negative cases) and group of incorrect diagnoses (false-positive, false-negative, and inconclusive cases). Univariate and multivariate logistic regression analyses were performed to analyze the differences of influencing factors (patient, pleura, and biopsy-associated factors) in the between the two groups.
RESULTS
Seven patients were excluded because of loss to follow-up. A total of 140 cases were ultimately included (105 males and 35 females). There were 105 cases in the correct diagnosis group, and 35 cases in the incorrect diagnosis group. The overall accuracy of US-PCNB was 75.0% and the sensitivity, specificity, PPV, NPV in malignant diagnosis were 58.1%, 99.0%, 96.2%, and 84.2%, respectively. On univariate analysis, variables affecting diagnostic accuracy of US-PCNB were the pleural thickness (<3 mm in thickness 61.0%, ≥3 mm in thickness 85.2%; P=0.001), morphology (non-nodular pleura 71.4%, nodular pleura 95.2%; P=0.026), and needle size (18 G 69.1%, 16 G 87.0%; P=0.022). Finally multivariate logistic regression demonstrated that pleural thickness [odds ratio (OR): 0.278, P=0.003] and needle size (OR: 0.291, P=0.018) independently predicted diagnostic accuracy.
CONCLUSIONS
Pleural thickness and the size of the biopsy needle were significantly correlated with the diagnostic yield.
背景
本研究的目的是回顾性调查超声引导下胸膜切割针活检（US引导的PCNB）的诊断准确性以及影响诊断率的潜在因素。
方法
回顾性分析2014年7月至2016年6月期间144例患者的147次经皮US引导的PCNB。最终诊断通过组织病理学分析和随访得以证实。我们计算了诊断准确性、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），并将所有病例分为正确诊断组（真阳性和真阴性病例）和错误诊断组（假阳性、假阴性和不确定病例）。进行单因素和多因素逻辑回归分析，以分析两组之间影响因素（患者、胸膜和活检相关因素）的差异。
结果
7例患者因失访被排除。最终纳入140例（男性105例，女性35例）。正确诊断组105例，错误诊断组35例。US-PCNB的总体准确率为75.0%，恶性诊断的敏感性、特异性、PPV、NPV分别为58.1%、99.0%、96.2%和84.2%。单因素分析显示，影响US-PCNB诊断准确性的变量包括胸膜厚度（厚度<3mm为61.0%，厚度≥3mm为85.2%；P=0.001）、形态（非结节状胸膜为71.4%，结节状胸膜为95.2%；P=0.026）和针的规格（18G为69.1%，16G为87.0%；P=0.022）。最终多因素逻辑回归表明，胸膜厚度[比值比（OR）：0.278，P=0.003]和针的规格（OR：0.291,P=0.018）独立预测诊断准确性。
结论
胸膜厚度和活检针的规格与诊断率显著相关。
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