Mychajlowycz Mirek, Alabousi Abdullah, Mironov Oleg
Department of Radiology, 3710McMaster University, Hamilton, Ontario, Canada.
Department of Radiology, 3710McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
Can Assoc Radiol J. 2021 Nov;72(4):883-889. doi: 10.1177/0846537120939073. Epub 2020 Jul 16.
To compare the wait times, safety, and diagnostic adequacy of computed tomography (CT)-guided percutaneous lung biopsies with ultrasound (US) guidance for subpleural lung and pleural lesions.
Consecutive CT- and US-guided biopsies performed at our institution between January 2018 and January 2019 were retrospectively reviewed. Biopsy wait times, lesion size, degree of pleural contact, procedure duration, number of needle passes, complications, and pathologic diagnosis were recorded and compared.
A total of 158 biopsies of subpleural or pleural-based lesions were reviewed. Forty-three cases utilized US guidance, while 115 cases used CT, 41 with conventional CT (CCT), and 74 with cone-beam CT guidance (CBCT). Overall, the mean lesion maximum axial diameter and length of pleural contact for US-guided biopsies was greater than for CT (4.8 ± 2.6 cm vs 3.2 ± 1.9 cm and 4.0 ± 2.5 cm vs 2.6 ± 1.7 cm, respectively, < .001). Wait times for US-guided biopsies were significantly shorter than CCT by 10.9 days on average while being equivalent to CBCT. Procedure time was shorter for lesions localized with US than CT (29.5 ± 16.4 minutes vs 37.6 ± 19.5 minutes, = .007) despite CT using less needle passes per lesion (3.5 ± 1.1 vs 3.1 ± 0.8, = .034). Sample adequacy was equivalent for both modalities (88% for US and 92% for CT). The frequency of pneumothoraces was similar between US (12%) and CT (15%).
Ultrasound and CT guidance have similar safety and diagnostic adequacy for subpleural lung and pleural biopsies. Ultrasound guidance has shorter wait and procedure times.
比较计算机断层扫描（CT）引导下经皮肺活检与超声（US）引导下对胸膜下肺和胸膜病变的等待时间、安全性及诊断充分性。
回顾性分析2018年1月至2019年1月在我院进行的连续CT引导和US引导下的活检。记录并比较活检等待时间、病变大小、胸膜接触程度、操作时间、穿刺针数、并发症及病理诊断。
共回顾了158例胸膜下或胸膜病变的活检。43例采用US引导，115例采用CT引导，其中41例采用传统CT（CCT）引导，74例采用锥形束CT引导（CBCT）。总体而言，US引导下活检的平均病变最大轴向直径和胸膜接触长度大于CT引导下活检（分别为4.8±2.6cm对3.2±1.9cm和4.0±2.5cm对2.6±1.7cm，P<0.001）。US引导下活检的等待时间平均比CCT短10.9天，与CBCT相当。尽管CT引导下每个病变的穿刺针数较少（3.5±1.1对3.1±0.8，P=0.034），但US引导下定位病变的操作时间比CT短（29.5±16.4分钟对37.6±19.5分钟，P=0.007）。两种方式的样本充足率相当（US为88%，CT为92%）。US引导组（12%）和气胸发生率与CT引导组（15%）相似。
超声和CT引导对胸膜下肺和胸膜活检具有相似的安全性和诊断充分性。超声引导的等待时间和操作时间更短。
