Fu Ying, Zhang Yuan-Yuan, Cui Li-Gang, Tan Shi, Sun Yan
Department of Ultrasound, Peking University Third Hospital, Beijing, China.
Front Pharmacol. 2019 Sep 3;10:960. doi: 10.3389/fphar.2019.00960. eCollection 2019.
In this study, a total of 58 patients with single subpleural pulmonary lesions (males: 36, females: 22, mean age: 63 ± 16.2 years) who underwent contrast-enhanced ultrasonography (CEUS) and had a definite diagnosis (benign lesions:25, malignant lesions:33) were enrolled. The number of biopsies, diagnostic accuracy rate, and the incidence of complications were recorded. The nodules were divided into two size subgroups: ≥5 cm (group 1), and <5 cm (group 2). The display rate of internal necrosis and change of pre-scheduled puncture paths were compared between subgroups. Also, the arrival times, intensity and uniformity of enhancement after the contrast agent injection, as well as the display rate of internal necrosis were recorded and compared between malignant and benign lesions. Finally, the average number of punctures was 2.9 ± 0.7 times. The total diagnosis rate was 98.3%. Local pneumothorax occurred in 2 patients. Hemoptysis occurred in 1 patient. No serious complications occurred. Internal necrosis was demonstrated in 20 of 58 lesions (34.5%). Sixteen of them had changed the planned puncture path due to the large necrosis area (80%, 16/20). For lesions in group 1, necrosis was found in 15 lesions and there was a statistically significant difference in the necrosis rate between the two subgroups (15/26 vs 5/32, = 0.001). The change in the pre-scheduled puncture path occurred in 12 patients in group 1 while 4 patients in group 2 exhibited a change in the planned puncture path ( = 0.004). There was a statistically significant difference in the arrival times and intensity of enhancement between benign and malignant lesions ( < 0.05). In conclusion, CEUS guided biopsy is an effective, sensitive, and safe method for the diagnosis of pleural-based pulmonary lesions by facilitating a distinction between necrosis and active tissue. The current findings indicated that CEUS before a biopsy may be especially vital in lesions ≥5 cm.
本研究共纳入58例接受超声造影（CEUS）检查且诊断明确（良性病变25例，恶性病变33例）的单纯胸膜下肺病变患者（男性36例，女性22例，平均年龄63±16.2岁）。记录活检次数、诊断准确率及并发症发生率。将结节分为两个大小亚组：≥5 cm（第1组）和<5 cm（第2组）。比较亚组间内部坏死的显示率及预定穿刺路径的变化。同时记录并比较恶性和良性病变注射造影剂后的到达时间、增强强度和均匀性以及内部坏死的显示率。最后，平均穿刺次数为2.9±0.7次。总诊断率为98.3%。2例患者发生局部气胸。1例患者出现咯血。未发生严重并发症。58个病变中有20个显示内部坏死（34.5%）。其中16个因坏死面积大而改变了计划穿刺路径（80%，16/20）。第1组病变中15个发现坏死，两个亚组的坏死率有统计学差异（15/26 vs 5/32，P = 0.001）。第1组12例患者的预定穿刺路径发生改变，而第2组4例患者的计划穿刺路径发生改变（P = 0.004）。良性和恶性病变的到达时间和增强强度有统计学差异（P<0.05）。总之，CEUS引导下活检是诊断胸膜下肺病变的一种有效、敏感且安全的方法，有助于区分坏死组织和活性组织。目前的研究结果表明，活检前的CEUS对≥5 cm的病变可能尤为重要。
