Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan; Department of Radiological Technology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan.
Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan.
Diagn Interv Imaging. 2022 Jun;103(6):302-309. doi: 10.1016/j.diii.2022.01.008. Epub 2022 Feb 8.
The purpose of this study was to evaluate retrospectively the safety and diagnostic yield of computed tomography (CT) fluoroscopy-guided biopsy for pulmonary lesions with interlobar fissure contact.
Seventy-two lesions showing interlobar fissure contact (mean size, 15.2 ± 5.3 [SD] mm [range: 5.3-27.0 mm]; mean length of interlobar fissure contact, 8.9 ± 3.6 [SD] mm [range: 2.6-17.5 mm] in 72 patients (33 men, 39 women; mean age, 69.7 ± 10.3 [SD] years; age range: 37-91 years) were evaluated. Multiple variables were assessed to determine the risk factors for diagnostic failure and pneumothorax. Additionally, these variables were compared between these 72 lesions and randomly selected controls (i.e., non-contact lesions).
All biopsies were technically successful using the transfissural (n = 14) or conventional routes (the route into the lung lobe with the target) with (n = 35) or without (n = 23) possible risk of needle insertion into the interlobar fissure after penetrating the target lesion. Sixty-eight (94.4%) procedures succeeded diagnostically and four (5.6%) failed. There were 27 grade I pneumothorax (37.5%), one (1.4%) grade II bleeding, and five (6.9%) grade IIIa pneumothorax requiring chest tube placement. Groups with and without pneumothorax did not differ significantly in patient-, lesion-, or procedure-related variables. Diagnostic yields and pneumothorax occurrence showed no significant differences between lesions with interlobar fissure contact and controls.
CT fluoroscopy-guided biopsy of pulmonary lesions with interlobar fissure contact is a safe procedure with a high diagnostic yield. Furthermore, because of potential complications, the transfissural route should be used only when a safer route is not possible.
本研究旨在回顾性评估 CT 透视引导下经叶间裂接触的肺病变活检的安全性和诊断率。
共评估了 72 例（33 例男性，39 例女性；平均年龄 69.7±10.3 岁[范围：37-91 岁]）显示叶间裂接触的病变（平均大小 15.2±5.3[SD]mm[范围：5.3-27.0mm]；平均叶间裂接触长度 8.9±3.6[SD]mm[范围：2.6-17.5mm]）。评估了多个变量，以确定诊断失败和气胸的危险因素。此外，还比较了这些变量在 72 个病变和随机选择的对照组（即无接触病变）之间的差异。
所有活检均通过经裂（n=14）或传统途径（目标进入肺叶的途径），经裂途径为（n=14）或不（n=35）经裂途径，技术上均成功。在穿透目标病变后，有可能将针插入叶间裂。68 例（94.4%）操作诊断成功，4 例（5.6%）失败。27 例（37.5%）为 I 级气胸，1 例（1.4%）为 II 级出血，5 例（6.9%）为 IIIa 气胸需放置胸腔引流管。气胸组和无气胸组在患者、病变或操作相关变量方面无显著差异。叶间裂接触病变和对照组的诊断率和气胸发生率无显著差异。
CT 透视引导下经叶间裂接触的肺病变活检是一种安全的操作，具有较高的诊断率。此外，由于潜在的并发症，只有在不可能采用更安全的途径时，才应使用经裂途径。
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