Burgard Caroline, Stahl Robert, de Figueiredo Giovanna Negrao, Dinkel Julien, Liebig Thomas, Cioni Dania, Neri Emanuele, Trumm Christoph G
Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany.
Institute for Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, 81377 Munich, Germany.
Diagnostics (Basel). 2021 Apr 26;11(5):781. doi: 10.3390/diagnostics11050781.
To evaluate technical outcome, diagnostic yield and safety of computed tomographic fluoroscopy-guided percutaneous core needle biopsies in patients with mediastinal masses.
Overall, 155 CT fluoroscopy-guided mediastinal core needle biopsies, performed from March 2010 to June 2020 were included. Size of lesion, size of needle, access path, number of success, number of biopsies per session, diagnostic yield, patient's position, effective dose, rate of complications, tumor localization, size of tumor and histopathological diagnosis were considered. Post-interventional CT was performed, and patients observed for any complications. Complications were classified per the Society of Interventional Radiology (SIR).
148 patients (age, 54.7 ± 18.2) underwent 155 CT-fluoroscopy-guided percutaneous biopsies with tumors in the anterior (114; 73.5%), middle (17; 11%) and posterior (24; 15.5%) mediastinum, of which 152 (98%) were technically successful. For placement of the biopsy needle, in 82 (52.9%) procedures a parasternal trajectory was chosen, in 36 (23.3%) a paravertebral access, in 20 (12.9%) through the lateral intercostal space and in 17 (11%) the thoracic anterior midline, respectively. A total of 136 (89.5%) of the biopsies were considered adequate for a specific histopathologic analysis. Total DLP (dose-length product) was 575.7 ± 488.8 mGy*cm. Mean lesion size was 6.0 ± 3.3 cm. Neoplastic pathology was diagnosed in 115 (75.7%) biopsies and 35 (23%) biopsy samples showed no evidence of malignancy. Minor complications were observed in 18 (11.6%) procedures and major pneumothorax requiring drainage insertion in 3 interventions (1.9%).
CT fluoroscopy-guided percutaneous core needle biopsy of mediastinal masses is an effective and safe procedure for the initial assessment of patients with mediastinal tumors.
评估计算机断层扫描透视引导下经皮芯针穿刺活检术在纵隔肿块患者中的技术效果、诊断率及安全性。
纳入2010年3月至2020年6月期间进行的155例计算机断层扫描透视引导下纵隔芯针穿刺活检病例。考虑病变大小、针的尺寸、进针路径、成功次数、每次活检次数、诊断率、患者体位、有效剂量、并发症发生率、肿瘤定位、肿瘤大小及组织病理学诊断。术后进行CT检查，并观察患者有无并发症。并发症按介入放射学会（SIR）标准分类。
148例患者（年龄54.7±18.2岁）接受了155次计算机断层扫描透视引导下经皮活检，肿瘤位于前纵隔（114例；73.5%）、中纵隔（17例；11%）和后纵隔（24例；15.5%），其中152例（98%）技术成功。对于活检针的放置，分别有82例（52.9%）采用胸骨旁路径、36例（23.3%）采用椎旁入路、20例（12.9%）经肋间外侧间隙、17例（11%）经胸前正中入路。共136例（89.5%）活检标本被认为足以进行特定的组织病理学分析。总剂量长度乘积（DLP）为575.7±488.8 mGy*cm。平均病变大小为6.0±3.3 cm。115例（75.7%）活检诊断为肿瘤性病变，35例（23%）活检标本未发现恶性证据。18例（11.6%）操作中观察到轻微并发症，3例（1.9%）干预中出现需要胸腔闭式引流的严重气胸。
计算机断层扫描透视引导下经皮芯针穿刺活检纵隔肿块是纵隔肿瘤患者初始评估的一种有效且安全的方法。
