用于预测经皮肺活检后需要住院治疗的主要并发症的计算机断层扫描评分方案：一项单中心回顾性研究
Proposal for a computed tomography score to predict major complications requiring hospitalization after percutaneous lung biopsy: a single-center retrospective study.
作者信息
Ortmans Satcha, de Oliveira Fabien, Serrand Chris, Kammoun Tarek, Greffier Joel, Dabli Djamel, de Forges Hélène, Rieux Cécile, Beregi Jean-Paul, Frandon Julien
机构信息
Department of Medical Imaging, PRIM Platform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, Nîmes, France.
Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology (BESPIM), Hospital University Center, Nîmes, France.
出版信息
Quant Imaging Med Surg. 2024 Sep 1;14(9):6830-6842. doi: 10.21037/qims-23-500. Epub 2024 Mar 12.
BACKGROUND
Image-guided percutaneous lung biopsy (PLB) may lead to major complications requiring hospitalization. This study aims to evaluate the rate of major PLB complications and determine a predictive computed tomography (CT) score to define patients requiring hospitalization due to these complications.
METHODS
This single-center retrospective study included all PLBs performed from July 2019 to December 2020 in Nimes University Hospital, France. Patients who were undergoing thermo-ablation during the same procedure or for whom PLB procedure data were not available were excluded. All major complications leading to hospitalization were recorded. A Percutaneous Image-guided Lung biopsy In/out Patient score (PILIP) based on variables significantly associated with major complications was calculated by multivariate analysis.
RESULTS
A total of 240 consecutive patients (160 men, 80 women; mean age: 67.3±10.5 years) were included. The major complication rate was 10.4%. Length of lung parenchyma traversed <20 . 20-40 mm [P=0.017, odds ratio (OR) =5.02; 95% confidence interval (CI): 1.33-18.92] and . >40 mm (P=0.010, OR =6.15; 95% CI: 1.54-24.53), middle . superior lobar location (P=0.011, OR =6.34; 95% CI: 1.53-26.31), emphysema along the needle pathway (P<0.0001, OR =10.96; 95% CI: 3.61-33.28), and pleural/scissural attraction (P=0.023, OR =3.50; 95% CI: 1.19-10.32) were independently associated with major complications. Based on these parameters, the PILIP made it possible to differentiate low-risk patients (PILIP <4) from those at high risk (PILIP ≥4) of major complications with 0.40 sensitivity (95% CI: 0.21-0.59), 0.95 specificity (95% CI: 0.93-0.98), a positive predictive value of 0.50 (95% CI: 0.28-0.72) and a negative predictive value of 0.93 (95% CI: 0.90-0.97).
CONCLUSIONS
PLB showed a major complication rate of 10.4%. The PILIP is an easy-to-use CT score for differentiating patients at a low or high risk of complications requiring hospitalization.
背景
影像引导下经皮肺活检（PLB）可能导致需要住院治疗的严重并发症。本研究旨在评估PLB严重并发症的发生率，并确定一个预测性计算机断层扫描（CT）评分，以界定因这些并发症而需要住院治疗的患者。
方法
这项单中心回顾性研究纳入了2019年7月至2020年12月在法国尼姆大学医院进行的所有PLB。排除在同一手术过程中接受热消融治疗的患者或无法获得PLB手术数据的患者。记录所有导致住院的严重并发症。通过多变量分析计算基于与严重并发症显著相关变量的经皮影像引导肺活检住院/出院患者评分（PILIP）。
结果
共纳入240例连续患者（160例男性，80例女性；平均年龄：67.3±10.5岁）。严重并发症发生率为10.4%。肺实质穿刺长度<20mm、20 - 40mm[P = 0.017，比值比（OR）= 5.02；95%置信区间（CI）：1.33 - 18.92]和>40mm（P = 0.010，OR = 6.15；95%CI：1.54 - 24.53），中叶/上叶位置（P = 0.011，OR = 6.34；95%CI：1.53 - 26.31），穿刺路径上的肺气肿（P < 0.0001，OR = 10.96；95%CI：3.61 - 33.28）以及胸膜/叶间裂吸引（P = 0.023，OR = 3.50；95%CI：1.19 - 10.32）与严重并发症独立相关。基于这些参数，PILIP能够区分严重并发症低风险患者（PILIP < 4）和高风险患者（PILIP≥4），其灵敏度为0.40（95%CI：0.21 - 0.59），特异度为0.95（95%CI：0.93 - 0.98），阳性预测值为0.50（95%CI：0.28 - 0.72），阴性预测值为0.93（95%CI：0.90 - 0.97）。
结论
PLB的严重并发症发生率为10.4%。PILIP是一种易于使用的CT评分，用于区分并发症导致住院的低风险或高风险患者。
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