超声造影引导胸膜活检提高胸膜病变的诊断信心：一项 3 年前瞻性研究。
Contrast-enhanced ultrasound guided pleural biopsy improves diagnostic confidence for pleural based lesions: a 3-year prospective study.
机构信息
Department of Tuberculosis and Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
出版信息
BMC Pulm Med. 2021 Jul 12;21(1):224. doi: 10.1186/s12890-021-01583-7.
OBJECTIVE
To evaluate the accuracy and safety of contrast-enhanced ultrasound (CEUS) guided biopsy in the diagnosis of radiologically determined pleural based lesions.
METHOD
A prospective study was conducted on patients with radiologically determined pleural based lesions. Patients who met the inclusion criteria received pleural biopsy guided by CEUS to obtain specimens, followed by histomathological and microbiological examinations. After treatment and follow-up, surgical thoracoscopy was performed on cases with undefinite diagnosis.
RESULT
A total of 460 patients were finally included. CEUS showed internal necrosis in 72.17% cases and obvious peripheral vessels in 55.43% cases, both of which were significantly higher than the conventional ultrasound imaged (p < 0.05). The diagnostic accuracy through CEUS guided biopsy sampling was 98.91% (455/460). The microbiological diagnostic yield achieved 71.88% (225/313) in infectious lesions. In 330 cases combined pleural effusion, CEUS guided biopsy increased the diagnostic yield from 60.30% (199 /330) to 98.36% (325 /330) in all cases (p < 0.05), from 15.56% (14/90) to 94.44% (85/90) in malignant lesions (p < 0.01) and from 77.08% (185/240) to 100% (240/240) in infectious lesions (p < 0.05). No serious adverse events occurred.
CONCLUSION
CEUS guided biopsy provides a minimally invasive, effective and safe diagnostic biopsy method for pleural lesions.
CLINICAL TRIALS REGISTRATION
Chinese Clinical Trial Registry ChiCTR2000029749 (ChiCTR, www.chictr.org.cn ).
目的
评估超声造影（CEUS）引导活检在诊断影像学确定的胸膜病变中的准确性和安全性。
方法
对影像学确定的胸膜病变患者进行前瞻性研究。符合纳入标准的患者接受 CEUS 引导的胸膜活检以获取标本，然后进行组织病理学和微生物学检查。治疗和随访后，对诊断不明确的病例进行手术胸腔镜检查。
结果
最终纳入 460 例患者。CEUS 显示 72.17%的病例内部坏死，55.43%的病例明显周边血管，均显著高于常规超声成像（p<0.05）。CEUS 引导活检取样的诊断准确性为 98.91%（455/460）。在感染性病变中，微生物学诊断率达到 71.88%（225/313）。在 330 例合并胸腔积液的病例中，CEUS 引导活检使所有病例的诊断率从 60.30%（199/330）提高到 98.36%（325/330）（p<0.05），从恶性病变的 15.56%（14/90）提高到 94.44%（85/90）（p<0.01），从感染性病变的 77.08%（185/240）提高到 100%（240/240）（p<0.05）。未发生严重不良事件。
结论
CEUS 引导活检为胸膜病变提供了一种微创、有效和安全的诊断性活检方法。
临床试验注册
中国临床试验注册中心 ChiCTR2000029749（ChiCTR，www.chictr.org.cn）。
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