Zhou Dazhi, Zhang Yuxin, Chen Wuxi, Jiang Juhong, Chen Yanbin, Zhou Xinghua, Tang Qing
Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
Quant Imaging Med Surg. 2022 Nov;12(11):5056-5067. doi: 10.21037/qims-22-119.
Though ultrasound-guided percutaneous lung needle biopsy (US-PLNB) is a first-line small biopsy method for peripheral lung lesions, quality of cellularity in specimens obtained via US-PLNB is uncertain. This study investigated the accuracy, sensitivity, and cellularity of US-PLNB. It examined the ability of contrast-enhanced ultrasound (CEUS) to improve the effectiveness of US-PLNB.
We retrospectively analyzed all data of patients with subpleural lung lesions who underwent US-PLNB. The cellularity of US-PLNB from malignant lesions included the tumor cell number and proportion. The definition of high-quality cellularity (HQC) was concurrently achieving a tumor cell number ≥400 and a proportion ≥20%. The sensitivity, the actual numbers of tumor cell number/proportion, and the rate of HQC were calculated and compared between the CEUS and non-enhanced US groups after propensity score matching (PSM) with subgroup analyses by lesion size (small lesion ≤30 mm and large lesion >30 mm).
A total of 345 patients undergoing 345 US-PLNBs were evaluated, with 3.7±1.1 of punctures on average. There were 201 malignant and 144 benign lesions with a mean size of 43.8±24.1 mm. Among the 201 malignant lesions, 124 cases underwent CEUS and 77 underwent non-enhanced US. The quantity of tumor cells, the proportion of tumor cells, and the rate of HQC in 201 cases of US-PLNB from malignant lesions were 2,862.1±2,288.0, 44.6%±24.5%, and 82.1% [95% confidence interval (CI): 76.6% to 87.1%], respectively. The quantity of tumor cells, the proportion of tumor cells, and rate of HQC were significantly higher in the CEUS group than that in the non-enhanced US group, both in the analysis of overall malignant lesions and in large malignant lesions (all P<0.05).
The US-PLNB has high sensitivity and thereby obtains HQC samples for subpleural lung malignant lesions. The CEUS helps improve the rate of HQC and tissue cellularity of lung malignancies.
尽管超声引导下经皮肺穿刺活检（US-PLNB）是外周肺病变的一线小活检方法，但通过US-PLNB获取的标本中细胞数量的质量尚不确定。本研究调查了US-PLNB的准确性、敏感性和细胞数量。研究了超声造影（CEUS）提高US-PLNB有效性的能力。
我们回顾性分析了所有接受US-PLNB的胸膜下肺病变患者的数据。恶性病变的US-PLNB细胞数量包括肿瘤细胞数量和比例。高质量细胞数量（HQC）的定义是同时达到肿瘤细胞数量≥400且比例≥20%。在倾向得分匹配（PSM）后，计算并比较CEUS组和非增强US组之间的敏感性、肿瘤细胞数量/比例的实际数量以及HQC率，并按病变大小（小病变≤30mm和大病变>30mm）进行亚组分析。
共评估了345例接受345次US-PLNB的患者，平均穿刺3.7±1.1次。有201例恶性病变和144例良性病变，平均大小为43.8±24.1mm。在201例恶性病变中，124例接受了CEUS检查，77例接受了非增强US检查。201例恶性病变的US-PLNB中，肿瘤细胞数量、肿瘤细胞比例和HQC率分别为2862.1±2288.0、44.6%±24.5%和82.1%[95%置信区间（CI）：76.6%至87.1%]。在总体恶性病变分析和大恶性病变分析中，CEUS组的肿瘤细胞数量、肿瘤细胞比例和HQC率均显著高于非增强US组（均P<0.05）。
US-PLNB具有较高的敏感性，从而为胸膜下肺恶性病变获取了HQC样本。CEUS有助于提高肺恶性肿瘤的HQC率和组织细胞数量。
