Zhou Zhen, Dong Yujie, Li Chenghai, Wang Dongpo, Lv Yan, Lv Pingxin, Pang Yu
Department of Radiology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China.
Department of Pathology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China.
J Thorac Dis. 2020 Aug;12(8):3987-3994. doi: 10.21037/jtd-19-3293.
The purpose of this study was to determine the optimal puncture site of computed tomography (CT)-guided transthoracic needle aspiration biopsy for the diagnosis of tuberculosis (TB) by the comparison of clinical and radiological characteristics of TB patients stratified to different histopathological results.
We retrospectively analysed the data of clinically diagnosed TB patients with negative laboratory results between July 2016 and June 2018. Biopsy specimens were obtained from patients for Ziehl-Neelsen (Z-N) staining and TB-DNA.
For the 356 TB patients, the positive rate of TB-DNA was 70.9%, which was significantly higher than that of Z-N staining (46.4%, P<0.001). The positive rate of lesions from upper lobe (76.4%, 155/203) was significantly higher than that from lower lobe (63.1%, 89/141, P=0.008). The mean of ΔCT density for positive histologic group (12.84±6.81 HU) was lower than that for negative histologic group (28.32±9.82 HU, P<0.001). ROC curve analysis revealed that a density-based cut-off value of 20.5 HU should be set as the cut-off values for determining the optimal puncture site.
Our data demonstrates that the molecular diagnostics has superiority over Z-N staining for detecting MTB from lung aspirates. The lung biopsies from upper lobe were more likely to yield positive histologic results than those from lower lobe. In addition, the enhancement of 20.5 HU by CT scans should be set as the cut-off values for determining the optimal puncture site that would facilitate an efficient diagnosis of pulmonary TB.
本研究旨在通过比较分层至不同组织病理学结果的肺结核（TB）患者的临床和放射学特征，确定计算机断层扫描（CT）引导下经胸针吸活检诊断肺结核的最佳穿刺部位。
我们回顾性分析了2016年7月至2018年6月临床诊断为肺结核但实验室结果为阴性的患者数据。从患者身上获取活检标本进行萋-尼（Z-N）染色和结核DNA检测。
356例肺结核患者中，结核DNA阳性率为70.9%，显著高于Z-N染色阳性率（46.4%，P<0.001）。上叶病变阳性率（76.4%，155/203）显著高于下叶病变阳性率（63.1%，89/141，P=0.008）。组织学阳性组的平均CT密度差值（12.84±6.81HU）低于组织学阴性组（28.32±9.82HU，P<0.001）。ROC曲线分析显示，应将基于密度的20.5HU截断值作为确定最佳穿刺部位的截断值。
我们的数据表明，分子诊断在从肺吸出物中检测结核分枝杆菌方面优于Z-N染色。上叶肺活检比下叶肺活检更有可能获得阳性组织学结果。此外，CT扫描增强20.5HU应作为确定最佳穿刺部位的截断值，这将有助于高效诊断肺结核。
