Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea.
Korean J Radiol. 2018 Sep-Oct;19(5):872-879. doi: 10.3348/kjr.2018.19.5.872. Epub 2018 Aug 6.
To evaluate the diagnostic performance of cone-beam computed tomography (CBCT) virtual navigation-guided percutaneous pleural biopsy for suspected malignant pleural disease.
This study enrolled 59 patients (31 males and 28 females; mean age, 63.4 years) with suspected malignant pleural disease diagnosed with CBCT from December 2010 to December 2016. Sixty-three CBCT-guided biopsies were performed using a coaxial system with 18- or 20-gauge cutting needles. Procedural details, diagnostic performance, radiation exposure, and complication rates were investigated.
The mean diameter perpendicular to the pleura of 51 focal and 12 diffuse pleural lesions was 1.53 ± 0.76 cm. The mean distance from the skin to the target was 3.40 ± 1.51 cm. Mean numbers of CT acquisitions and biopsies were 3.21 ± 0.57 and 3.05 ± 1.54. Total procedure time and coaxial introducer indwelling time were 11.87 ± 5.59 min and 8.78 ± 4.95 min, respectively. The mean dose area product was 12013.61 ± 7969.59 mGym. There were 48 malignant, 10 benign, and 5 indeterminate lesions. Sensitivity, specificity, and diagnostic accuracy were 93.8% (45/48), 100% (10/10), and 94.8% (55/58), respectively. Positive and negative predictive values for malignancy were 100% (45/45) and 76.9% (10/13), respectively. Four patients (6.8%) with benign pathology during initial biopsy but still showing a high suspicion of malignancy underwent repeat biopsy and three of them were finally diagnosed with malignant pleural disease. There were three cases of minimal pneumothorax and no grave procedure-related complications.
Cone-beam computed tomography-guided biopsy is an accurate and safe diagnostic technique for suspected malignant pleural lesion with reasonable radiation exposure and procedure time.
评估锥形束 CT（CBCT）虚拟导航引导经皮胸膜活检对疑似恶性胸膜疾病的诊断性能。
本研究纳入了 2010 年 12 月至 2016 年 12 月期间经 CBCT 诊断为疑似恶性胸膜疾病的 59 例患者（31 名男性和 28 名女性；平均年龄 63.4 岁）。使用同轴系统和 18 或 20 号切割针进行了 63 次 CBCT 引导活检。研究了操作细节、诊断性能、辐射暴露和并发症发生率。
51 个局灶性和 12 个弥漫性胸膜病变垂直于胸膜的平均直径为 1.53 ± 0.76cm。从皮肤到目标的平均距离为 3.40 ± 1.51cm。平均 CT 采集次数和活检次数分别为 3.21 ± 0.57 和 3.05 ± 1.54。总手术时间和同轴导入器留置时间分别为 11.87 ± 5.59min 和 8.78 ± 4.95min。平均剂量面积乘积为 12013.61 ± 7969.59mGym。其中 48 例为恶性，10 例为良性，5 例为不确定。敏感性、特异性和诊断准确性分别为 93.8%（45/48）、100%（10/10）和 94.8%（55/58）。恶性的阳性和阴性预测值分别为 100%（45/45）和 76.9%（10/13）。4 例（6.8%）初始活检为良性病理但仍高度怀疑恶性的患者接受了重复活检，其中 3 例最终诊断为恶性胸膜疾病。有 3 例出现轻微气胸，无严重与操作相关的并发症。
锥形束 CT 引导活检是一种准确、安全的诊断技术，适用于疑似恶性胸膜病变，辐射暴露和操作时间合理。
