Department of Diagnostic Radiology, Chang-Gung Memorial Hospital, Chiayi branch, Chiayi, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Cancer Imaging. 2019 Jul 23;19(1):51. doi: 10.1186/s40644-019-0240-6.
Computed tomography (CT)-guided pulmonary core biopsies of small pulmonary nodules less than 15 millimeters (mm) are challenging for radiologists, and their diagnostic accuracy has been shown to be variable in previous studies. Common complications after the procedure include pneumothorax and pulmonary hemorrhage. The present study compared the diagnostic accuracy of small and large lesions using CT-guided core biopsies and identified the risk factors associated with post-procedure complications.
Between January 1, 2016, and December 31, 2017, 198 CT-guided core biopsies performed on 195 patients at our institution were retrospectively enrolled. The lesions were separated into group A (< or = 15 mm) and group B (> 15 mm) according to the longest diameter of the target lesions on CT. Seventeen-gauge introducer needles and 18-gauge automated biopsy instruments were coaxially used for the biopsy procedures. The accuracy and complications, including pneumothorax and pulmonary hemorrhage, of the procedures of each group were recorded. The risk factors for pneumothorax and pulmonary hemorrhage were determined using univariate analysis of variables.
The diagnostic accuracies of group A (n = 43) and group B (n = 155) were 83.7 % and 96.8 %, respectively (p = 0.005). The risk factors associated with post-biopsy pneumothorax were longer needle path length from the pleura to the lesion (p = 0.020), lesion location in lower lobes (p = 0.002), and patients with obstructive lung function tests (p = 0.034). The risk factors associated with post-biopsy pulmonary hemorrhage were longer needle path length from the pleura to the lesion (p < 0.001), smaller lesions (p < 0.001), non-pleural contact lesions (p < 0.001), patients without restrictive lung function tests (p = 0.034), and patients in supine positions (p < 0.003).
CT-guided biopsies of small nodules equal to or less than 15 mm using 17-gauge guiding needles and 18-gauge biopsy guns were accurate and safe. The biopsy results of small lesions were less accurate than those of large lesions, but the results were a reliable reference for clinical decision-making. Understanding the risk factors associated with the complications of CT-guided biopsies is necessary for pre-procedural planning and communication.
对于放射科医生来说，小于 15 毫米（mm）的肺部小结节的 CT 引导下肺核心活检具有挑战性，其诊断准确性在以前的研究中存在差异。该操作后常见的并发症包括气胸和肺出血。本研究比较了 CT 引导下肺核心活检术对小病灶和大病灶的诊断准确性，并确定了与术后并发症相关的危险因素。
回顾性纳入 2016 年 1 月 1 日至 2017 年 12 月 31 日在我院进行的 198 例 CT 引导下肺核心活检术的 195 例患者，根据 CT 上目标病灶的最长直径将病灶分为 A 组（≤15mm）和 B 组（＞15mm）。活检操作使用 17 号引导针和 18 号自动活检枪同轴进行。记录两组操作的准确性和并发症，包括气胸和肺出血。使用单变量分析变量确定气胸和肺出血的危险因素。
A 组（n=43）和 B 组（n=155）的诊断准确率分别为 83.7%和 96.8%（p=0.005）。与活检后气胸相关的危险因素为从胸膜到病变的针道长度较长（p=0.020）、病变位于下叶（p=0.002）、阻塞性肺功能检查患者（p=0.034）。与活检后肺出血相关的危险因素为从胸膜到病变的针道长度较长（p＜0.001）、病变较小（p＜0.001）、无胸膜接触病变（p＜0.001）、限制性肺功能检查患者（p=0.034）和仰卧位患者（p＜0.003）。
使用 17 号引导针和 18 号活检枪对直径等于或小于 15mm 的小结节进行 CT 引导下活检是准确和安全的。小病灶的活检结果不如大病灶准确，但为临床决策提供了可靠的参考。了解 CT 引导下活检相关并发症的危险因素，有利于术前规划和医患沟通。
