Huang Weijun, Ye Jieyi, Qiu Yide, Peng Weiwei, Lan Ninghui, Huang Ting, Ou Yinghui, Deng Xiaoyun, Li Yingjia
Department of Medical Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Division of Interventional Ultrasound, Department of Medical Ultrasonics, Foshan First People's Hospital (The Affiliated Foshan Hospital of Sun Yat-sen University), Foshan, China.
Front Oncol. 2021 May 14;11:671884. doi: 10.3389/fonc.2021.671884. eCollection 2021.
To evaluate diagnostic performance and safety of ultrasound-guided needle biopsy in the diagnosis of peripheral pulmonary nodules (PPLs) ≤ 2 cm, and the influence factors of sample adequacy and safety.
194 patients (99 men, 95 women; mean age, 56.2 ± 13.7 years) who received biopsy for PPLs ≤ 2 cm between January 2014 to January 2019 were included. Variables including patient demographics, lesion location, lesion size, presence of lesion necrosis, presence of emphysema on CT, patient position, biopsy needle size and number of needle passes were recorded. Univariate analysis and multivariate logistic regression analysis were performed to explore the influence factor of sample adequacy and safety.
Biopsy specimens were adequate for diagnosis in 161/194 (83%) cases; the diagnostic accuracy was 81.4% (158/194). The overall complication rate was 8.8% (17/194), including pneumothorax, hemoptysis and pleural effusion, which occurred in 2.1% (4/194), 5.2% (10/194), and 1.5% (3/194) of patients, respectively. The incidence of pneumothorax in the 16-gauge-needle group were significantly higher than that of the 18-gauge-needle group (5.6% 0%, =0.018). Adequate sampling of 16-gauge and 18-gauge needles were achieved in 90.3%(65/72) and 78.7%(96/122) cases, respectively. Multivariate logistic regression analysis revealed needle size (16-gauge 18-gauge) was an independent influence factors of sample adequacy (=0.015, odds ratio=3.419). A receiver operating characteristic curve was plotted and the area under the curve was 0.774.
US-guided percutaneous needle biopsy is a feasible and safe technique for small PPLs ≤ 2 cm. Needle size is an independent influence factor of sample adequacy and post-procedure pneumothorax. Sixteen-gauge needle has the advantage of achieving adequate sample for pathological analysis, though the risk of pneumothorax should be alerted.
评估超声引导下经皮穿刺活检对直径≤2 cm的周围型肺结节（PPL）的诊断效能及安全性，以及样本充足率和安全性的影响因素。
纳入2014年1月至2019年1月期间接受直径≤2 cm的PPL活检的194例患者（男性99例，女性95例；平均年龄56.2±13.7岁）。记录患者人口统计学资料、病变位置、病变大小、病变坏死情况、CT上肺气肿情况、患者体位、活检针规格及穿刺针数等变量。采用单因素分析和多因素logistic回归分析探讨样本充足率和安全性的影响因素。
194例患者中161例（83%）的活检标本足够用于诊断；诊断准确率为81.4%（158/194）。总体并发症发生率为8.8%（17/194），包括气胸、咯血和胸腔积液，分别发生在2.1%（4/194）、5.2%（10/194）和1.5%（3/194）的患者中。16G穿刺针组气胸发生率显著高于18G穿刺针组（5.6%对0%，P = 0.018）。16G和18G穿刺针的样本充足率分别为90.3%（65/72）和78.7%（96/122）。多因素logistic回归分析显示穿刺针规格（16G对18G）是样本充足率的独立影响因素（P = 0.015，比值比 = 3.419）。绘制受试者工作特征曲线，曲线下面积为0.774。
超声引导下经皮穿刺活检对于直径≤2 cm的小PPL是一种可行且安全的技术。穿刺针规格是样本充足率和术后气胸的独立影响因素。16G穿刺针在获取足够病理分析样本方面具有优势，不过应警惕气胸风险。
