Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
Korean J Radiol. 2021 Jul;22(7):1203-1212. doi: 10.3348/kjr.2020.1229. Epub 2021 Apr 9.
To investigate the diagnostic accuracy and complications of cone-beam CT-guided percutaneous transthoracic needle biopsy (PTNB) of juxtaphrenic lesions and identify the risk factors for diagnostic failure and complications.
In total, 336 PTNB procedures for lung lesions (mean size ± standard deviation [SD], 4.3 ± 2.3 cm) abutting the diaphragm in 326 patients (189 male and 137 female; mean age ± SD, 65.2 ± 11.4 years) performed between January 2010 and December 2014 were included. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the PTNB procedures for the diagnosis of malignancy were measured based on the intention-to-diagnose principle. The risk factors for diagnostic failures and complications were evaluated using logistic regression analysis.
The accuracy, sensitivity, specificity, PPV, and NPV were 92.7% (293/316), 91.3% (219/240), 91.4% (74/81), 96.9% (219/226), and 77.9% (74/95), respectively. There were 23 diagnostic failures (7.3%), and lesion sizes ≤ 2 cm ( = 0.045) were the only significant risk factors for diagnostic failure. Complications occurred in 98 cases (29.2%), including 89 cases of pneumothorax (26.5%) and 7 cases of hemoptysis (2.1%). The multivariable analysis showed that old age (> 65 years) ( = 0.002), lesion size of ≤ 2 cm ( = 0.003), emphysema ( = 0.006), and distance from the pleura to the target lesion (> 2 cm) ( = 0.010) were significant risk factors for complications.
The diagnostic accuracy of cone-beam CT-guided PTNB of juxtaphrenic lesions for malignancy was fairly high, and the target lesion size was the only significant predictor of diagnostic failure. Complications of cone-beam CT-guided PTNB of juxtaphrenic lesions occurred at a reasonable rate.
研究锥形束 CT 引导下经胸肺周围病变穿刺活检（PTNB）的诊断准确性和并发症，并确定诊断失败和并发症的危险因素。
共纳入 2010 年 1 月至 2014 年 12 月期间 326 例患者（189 名男性和 137 名女性；平均年龄±标准差，65.2±11.4 岁）336 例毗邻膈肌的肺部病变（平均大小±标准差，4.3±2.3cm）的 PTNB 手术。基于意向诊断原则，测量 PTNB 手术对恶性肿瘤诊断的准确性、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。使用逻辑回归分析评估诊断失败和并发症的危险因素。
诊断的准确性、敏感性、特异性、PPV 和 NPV 分别为 92.7%（293/316）、91.3%（219/240）、91.4%（74/81）、96.9%（219/226）和 77.9%（74/95）。有 23 例诊断失败（7.3%），病变大小≤2cm（ = 0.045）是诊断失败的唯一显著危险因素。98 例（29.2%）发生并发症，包括 89 例气胸（26.5%）和 7 例咯血（2.1%）。多变量分析显示，年龄较大（>65 岁）（ = 0.002）、病变大小≤2cm（ = 0.003）、肺气肿（ = 0.006）和胸膜到目标病变的距离（>2cm）（ = 0.010）是并发症的显著危险因素。
锥形束 CT 引导下经胸肺周围病变穿刺活检对恶性肿瘤的诊断准确性相当高，目标病变大小是诊断失败的唯一显著预测因素。锥形束 CT 引导下经胸肺周围病变穿刺活检的并发症发生率合理。
