采用倾向评分匹配分析比较超声引导下经皮肺外周病变活检中 16 号和 18 号针的疗效和安全性。
Propensity-score-matching analysis to compare efficacy and safety between 16-gauge and 18-gauge needle in ultrasound-guided biopsy for peripheral pulmonary lesions.
机构信息
Department of Medical Ultrasonics, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
Division of Interventional Ultrasound, Department of Medical Ultrasonics, Foshan First People's Hospital (The Affiliated Foshan Hospital of Sun Yat-sen University), 81 Lingnan North Road, Foshan, 528000, Guangdong, China.
出版信息
BMC Cancer. 2021 Apr 9;21(1):390. doi: 10.1186/s12885-021-08126-7.
BACKGROUND
Definitive diagnosis of peripheral pulmonary lesions (PPLs) depends on the histological analysis of the pleural biopsy sample. Ultrasound (US)-guided sampling is now standard practice in the clinical setting. However, determining a suitable needle size and sampling times to improve the efficacy and safety of the biopsy remains challenging. Here, we compared the efficacy between 16- and 18-gauge core biopsy needles in US-guided percutaneous transthoracic biopsy for PPLs on histological diagnosis and procedure-related complications.
MATERIALS AND METHODS
In total, 1169 patients (767 men, 402 women; mean age, 59.4 ± 13.2 years) who received biopsy for PPLs between September 2011 and February 2019 were included. The propensity score matching (PSM) analysis was performed to adjust the baseline differences, and the rate of successful specimen assessment and complications were compared between the 16-gauge (249 patients) and 18-gauge (920 patients) groups. The number of pleural surfaces crossed (NOPSC) was defined as the number of times the visceral pleural surface was transgressed. Stratified analysis was performed based on NOPSC.
RESULTS
The overall success rate was 92.0% (1076/1169). The overall complication rate was 9.6%, including pneumothorax, hemorrhage, and vasovagal reaction, which occurred in 2.5% (29/1169), 6.6% (77/1169), and 0.5% (6/1169) of the patients, respectively. When NOPSC was 1 or > 2, the success and complication rates in the 16-gauge group were comparable to those of the 18-gauge group (all P > 0.05). When the NOPSC was 2, the success rate in the 16-gauge group was significantly higher than that in the 18-gauge group (P = 0.017), whereas the complication rate was comparable (P > 0.05).
CONCLUSION
Higher success rate could be achieved using a 16-gauge than an 18-gauge core biopsy needle in the US-guided percutaneous transthoracic biopsy for PPLs when the NOPSC was 2. We recommend using 16-gauge needles with 2 times of needle passes in biopsy for PPLs in clinical practice.
背景
外周肺病变（PPL）的明确诊断取决于胸膜活检样本的组织学分析。超声（US）引导下的取样现在是临床实践中的标准操作。然而，确定合适的针大小和取样次数以提高活检的效果和安全性仍然具有挑战性。在这里，我们比较了 16 号和 18 号活检针在 US 引导下经皮经胸活检 PPL 进行组织学诊断和与程序相关的并发症方面的效果。
材料和方法
共纳入 2011 年 9 月至 2019 年 2 月期间因 PPL 接受活检的 1169 例患者（767 例男性，402 例女性；平均年龄 59.4±13.2 岁）。采用倾向评分匹配（PSM）分析来调整基线差异，并比较 16 号（249 例）和 18 号（920 例）组之间成功评估标本和并发症的比率。定义胸膜表面交叉次数（NOPSC）为脏层胸膜表面交叉的次数。根据 NOPSC 进行分层分析。
结果
总体成功率为 92.0%（1076/1169）。总体并发症发生率为 9.6%，包括气胸、出血和血管迷走神经反应，分别发生在 2.5%（29/1169）、6.6%（77/1169）和 0.5%（6/1169）的患者中。当 NOPSC 为 1 或>2 时，16 号组的成功率和并发症发生率与 18 号组相当（均 P>0.05）。当 NOPSC 为 2 时，16 号组的成功率明显高于 18 号组（P=0.017），而并发症发生率相当（P>0.05）。
结论
在 US 引导下经皮经胸活检 PPL 时，NOPSC 为 2 时，使用 16 号活检针比 18 号活检针可获得更高的成功率。我们建议在临床实践中对 PPL 使用 16 号针进行 2 次穿刺活检。
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