Department of Radiology, Hyogo Medical University, Nishinomiya, Japan
Department of Radiology, Hyogo Medical University, Nishinomiya, Japan.
In Vivo. 2023 Sep-Oct;37(5):2237-2243. doi: 10.21873/invivo.13325.
BACKGROUND/AIM: This is a retrospective evaluation of whether percutaneous direct puncture biopsy of lung lesions contacting to the pleura is justified.
Between August 2016 and July 2021, 163 consecutive patients (100 males, 63 females with a median age of 73 years) who had malignant lung tumors measuring 0.6-12.4 cm (median, 2.9 cm) that contacted to the pleura and underwent percutaneous lung biopsy under computed tomography fluoroscopic guidance using an 18-gauge end-cut needle were examined. The trajectory was direct puncture in 80 patients (49.1%, 80/163), and trans-lung in 83 patients (50.9%, 83/163). Diagnostic yield and major adverse event rates of direct and trans-lung puncture biopsies were compared.
No difference was found in diagnostic yield between direct puncture and trans-lung biopsies (93.8% vs. 98.8%, p=0.11). Major adverse events were major pneumothorax (n=13/163, 8.0%), pleural dissemination (n=18/163, 11.0%), and hemothorax requiring arterial embolization (n=1/163, 1.0%). Direct puncture caused major pneumothorax significantly less than trans-lung puncture did (0%, 0/80 vs. 15.7%, 13/83, p<0.001). No significant difference was found between the two biopsy methods regarding the incidence of pleural dissemination (11.0%, 11/80 vs. 8.4%, 7/83, p=0.32).
Direct puncture biopsy of malignant lung tumors contacting to the pleura is justified.
背景/目的：本研究旨在回顾性评估肺病变与胸膜接触的经皮直接穿刺活检是否合理。
2016 年 8 月至 2021 年 7 月，163 例连续患者（男性 100 例，女性 63 例，中位年龄 73 岁）接受了经 CT 透视引导下使用 18 号端切针的经皮肺活检，这些患者的恶性肺肿瘤大小为 0.6-12.4cm（中位数，2.9cm），且与胸膜接触。其中 80 例患者（49.1%，80/163）采用直接穿刺路径，83 例患者（50.9%，83/163）采用经肺穿刺路径。比较直接和经肺穿刺活检的诊断率和主要不良事件发生率。
直接穿刺和经肺穿刺活检的诊断率无差异（93.8% vs. 98.8%，p=0.11）。主要不良事件为大量气胸（n=13/163，8.0%）、胸膜播散（n=18/163，11.0%）和需要动脉栓塞的血胸（n=1/163，1.0%）。直接穿刺导致大量气胸的发生率明显低于经肺穿刺（0%，0/80 vs. 15.7%，13/83，p<0.001）。两种活检方法的胸膜播散发生率无显著差异（11.0%，11/80 vs. 8.4%，7/83，p=0.32）。
肺病变与胸膜接触的经皮直接穿刺活检是合理的。
