Welborn Seth L, Ohori N Paul, Nason Katie S, Pennathur Arjun, Awais Omar, Christie Neil A, Luketich James D, Schuchert Matthew J
Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa.
J Thorac Cardiovasc Surg. 2019 Mar;157(3):1239-1245. doi: 10.1016/j.jtcvs.2018.09.125. Epub 2018 Nov 13.
Computed tomography-guided fine needle aspiration (CT-FNA) biopsy is a well-established diagnostic technique in the evaluation of lung nodules that is performed by radiologists in most centers. In this series, we analyzed the diagnostic and perioperative outcomes following CT-FNA performed by a dedicated group of thoracic surgeons.
We conducted a retrospective analysis of 955 patients undergoing CT-FNA by the thoracic surgery service. Primary outcome variables included diagnostic yield and accuracy, number of needle passes, complication rates, and adequacy of specimen for molecular testing.
A satisfactory diagnostic specimen was obtained in 94.1% of cases. The average number of needle passes was 3.2 ± 1.5 (range, 1-10 passes). Diagnostic yield was significantly improved by increasing the number of passes from 1 to 2 to 3 passes (P = .0003). CT-FNA diagnostic accuracy was 88.8%. Diagnostic accuracy did not significantly improve with ≥4 passes (P = .20). Molecular testing was successful in 43.1%, and did not improve with ≥4 passes (P = .5). Molecular testing success did improve with the addition of core needle biopsy (P = .005). The pneumothorax rate for CT-FNA alone was 26.4%, and increased with ≥4 passes (P = .009). The median length of stay for CT-FNA alone was 0 days (range, 0-74 days), with same-day discharge in 67.5% of patients.
Thoracic surgeons can perform CT-FNA with excellent diagnostic yield and accuracy. Diagnostic yield, accuracy, and success in molecular testing do not improve with ≥4 CT-FNA passes. Pneumothorax rates do increase with ≥4 passes. The addition of core needle biopsy enhances success with molecular testing.
计算机断层扫描引导下细针穿刺（CT-FNA）活检是评估肺结节的一项成熟诊断技术，在大多数中心由放射科医生操作。在本系列研究中，我们分析了由一组专业胸外科医生进行CT-FNA后的诊断及围手术期结果。
我们对胸外科进行CT-FNA的955例患者进行了回顾性分析。主要结局变量包括诊断率和准确性、穿刺次数、并发症发生率以及用于分子检测的标本充足性。
94.1%的病例获得了满意的诊断标本。平均穿刺次数为3.2±1.5次（范围为1至10次）。将穿刺次数从1次增加到2次再到3次，诊断率显著提高（P = 0.0003）。CT-FNA诊断准确性为88.8%。穿刺≥4次时诊断准确性未显著提高（P = 0.20）。43.1%的分子检测成功，穿刺≥4次时未改善（P = 0.5）。增加粗针活检后分子检测成功率提高（P = 0.005）。单纯CT-FNA气胸发生率为26.4%，穿刺≥4次时增加（P = 0.009）。单纯CT-FNA的中位住院时间为0天（范围为0至74天），67.5%的患者当日出院。
胸外科医生进行CT-FNA可获得优异的诊断率和准确性。穿刺≥4次时，诊断率、准确性及分子检测成功率并未提高。穿刺≥4次时气胸发生率确实增加。增加粗针活检可提高分子检测成功率。
