Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
Acta Radiol. 2022 May;63(5):606-614. doi: 10.1177/02841851211005087. Epub 2021 Apr 27.
Pulmonary infection is a major cause of morbidity and mortality in immunocompromised patients, in whom diagnostic yields of cone-beam computed tomography (CBCT)-guided percutaneous transthoracic needle biopsies (PTNBs) have not been evaluated so far.
To evaluate diagnostic yields and complications of CBCT-guided PTNBs in immunocompromised patients.
From January 2015 to January 2018, 43 patients (25 men, 18 women; mean age 54.1 ± 16.4 years) who were suspected of having pulmonary infections were included in this retrospective study. Electronic medical records and radiologic studies were reviewed, including the underlying medical status, information on target lesions, PTNB procedural factors, and pathologic results. Logistic regression was performed to explore factors related with post-PTNB complications.
Among 43 patients, specific causative organisms or family of organisms were identified by PTNBs in 16 patients (37.2%). The most common causative organism was fungus (10/16, 62.5%), while bacterial infection was pathologically proven only in one patient (6.3%). Clinically significant change in management occurred in 12 of 43 patients (27.9%). Post-PTNB complications developed in 12 patients (27.9%; pneumothorax [n = 6] and hemoptysis [n = 6]) without PTNB-related mortality. Lower lobar location (odds ratio [OR] = 0.07, = 0.006) was related with post-PTNB pneumothorax, while lower platelet counts (≤127 × 10/µL) were associated with post-PTNB hemoptysis (OR = 9.82, = 0.025).
CBCT-guided PTNBs revealed microbiological pathogens in 37.2% of immunocompromised patients and led to subsequent clinical actions in 27.9% of patients. Post-PTNB complications occurred in 27.9% of patients, and it might be necessary to perform PTNBs more carefully in immunocompromised patients with lower platelet counts.
肺部感染是免疫功能低下患者发病率和死亡率的主要原因，目前尚未评估锥形束 CT（CBCT）引导下经皮肺穿刺活检（PTNB）在免疫功能低下患者中的诊断效果。
评估 CBCT 引导下 PTNB 在免疫功能低下患者中的诊断效果和并发症。
回顾性分析 2015 年 1 月至 2018 年 1 月期间 43 例（男 25 例，女 18 例；平均年龄 54.1±16.4 岁）疑似肺部感染患者的资料。电子病历和影像学研究包括基础医学状况、目标病变信息、PTNB 程序因素和病理结果。采用逻辑回归分析探讨与 PTNB 后并发症相关的因素。
43 例患者中，16 例（37.2%）通过 PTNB 确定了特定的病原体或病原体家族。最常见的病原体是真菌（10/16，62.5%），而只有 1 例（6.3%）患者的细菌感染得到了病理证实。43 例患者中有 12 例（27.9%）患者的临床管理发生了显著变化。43 例患者中有 12 例（27.9%）出现 PTNB 后并发症（气胸 6 例，咯血 6 例），无 PTNB 相关死亡。下叶部位（比值比[OR] = 0.07， = 0.006）与 PTNB 后气胸有关，而血小板计数较低（≤127×10/µL）与 PTNB 后咯血有关（OR = 9.82， = 0.025）。
CBCT 引导下 PTNB 在 37.2%的免疫功能低下患者中发现了微生物病原体，并导致 27.9%的患者采取了后续的临床措施。PTNB 后并发症发生率为 27.9%，血小板计数较低的免疫功能低下患者可能需要更小心地进行 PTNB。
