Hu Mu, Liu Lei, Qian Kun, Li Yuanbo, Zhi Xiuyi
Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Zhongguo Fei Ai Za Zhi. 2018 Sep 20;21(9):682-685. doi: 10.3779/j.issn.1009-3419.2018.09.06.
When lung cancer screening work extensively developed in recent years, more and more small lung lesions were found in clinic. The aim of this study is to analysis computed tomography (CT) guided percutaneous biopsy for lung small lesions (diameter<2 cm) on results, complications and prognosis.
Choose CT guided percutaneous lung biopsy were performed in 41 cases of pulmonary peripheral lesions, single lesion in 39 cases, multiple lesions in 2 cases, 5-20 (13.1±5.2) mm in maximum diameter, depth from lung surface 1-45 (16.5±13.7) mm, ground-glass opacity (GGO) components 0%-100% (66.8%±35.2%).
41 patients and 43 biopsies successfully obtained pathological tissue. Atypical adenomatous hyperplasia in 3 cases, squamous carcinoma in 1 case, adenocarcinoma in 37 cases( carcinoma in situ in 7 cases, micro-invasive carcinoma in 5 cases, invasive adenocarcinoma in 25 cases, double primary lung cancer in 2 cases), inflammatory lesions in 2 cases. Except 2 cases of inflammatory lesions are in follow-up, biopsy and surgical pathology alignment (specificity) was 100%. 41 patients occurred complications related to percutaneous biopsy. Pneumothorax were in 22 cases, drainage required in 2 cases. There were 17 cases with hemoptysis, accounting for 39.5% incidence are self-limited. Intracranial air embolism occurred in 2 cases by 4.6% incidence. They were fully recovered.
For small lung lesions, CT guided percutaneous biopsy is technically feasible. However, for small lung lesions especially pure GGO biopsy, it is still need to be cautious.
近年来肺癌筛查工作广泛开展，临床上发现越来越多的肺小结节。本研究旨在分析计算机断层扫描（CT）引导下经皮肺穿刺活检对肺小结节（直径<2 cm）的诊断结果、并发症及预后情况。
选取41例行CT引导下经皮肺穿刺活检的肺外周病变患者，其中单发病变39例，多发病变2例，最大直径5 - 20（13.1±5.2）mm，距肺表面深度1 - 45（16.5±13.7）mm，磨玻璃密度影（GGO）成分0% - 100%（66.8%±35.2%）。
41例患者43次活检均成功获取病理组织。其中非典型腺瘤样增生3例，鳞癌1例，腺癌37例（原位癌7例，微浸润癌5例，浸润性腺癌25例，双原发性肺癌2例），炎性病变2例。除2例炎性病变在随访中外，活检与手术病理符合率（特异性）为100%。41例患者发生与经皮活检相关的并发症。气胸22例，其中2例需行胸腔闭式引流。咯血17例，发生率39.5%，均为自限性。颅内空气栓塞2例，发生率4.6%，均完全恢复。
对于肺小结节，CT引导下经皮肺穿刺活检技术上可行。然而，对于肺小结节尤其是纯磨玻璃密度影的活检仍需谨慎。
