Haramati L B
Department of Radiology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
AJR Am J Roentgenol. 1995 Jul;165(1):53-5. doi: 10.2214/ajr.165.1.7785631.
The purpose of this study was to determine the diagnostic accuracy and frequency of complications of CT-guided transthoracic needle biopsy done with an automated biopsy system.
Thirty-three consecutive biopsies were performed on 32 patients between February 1992 and July 1994 (mean age, 55 +/- 15 years; 18 men and 14 women). An 18-gauge (n = 28) or 20-gauge (n = 5) needle was used. Core specimens were submitted for pathologic examination in 10% formalin. No cytopathologist or frozen section analysis was available at the time of biopsy. All biopsies but one were performed by one chest radiologist.
Thirty-one lung biopsies and two mediastinal biopsies yielded a mean lesion size of 4.0 cm (range, 1.2-13.0 cm). Postbiopsy pneumothorax occurred in three (9%) of 33 biopsies; none of the pneumothoraces required placement of a chest tube. The mean number of needle passes was 1.3 (+/- 0.6). Thirty biopsies (91%) yielded sufficient tissue for pathologic evaluation. The diagnoses included carcinoma in 14 cases, acute or chronic pneumonia in 4 cases, non-Hodgkin's lymphoma in two cases, and Kaposi's sarcoma, plasma cell granuloma, hypersensitivity pneumonitis, Pneumocystis carinii pneumonia, and fibrosis in one case each. One patient with a 1.5-cm nodule stable for 1 year on CT had fibrosis and chronic inflammation found on needle biopsy, and the nodule was considered benign. Overall, biopsies in 12 (80%) of 15 patients without carcinoma were diagnostic. In three patients, the tissue obtained was not representative of the underlying abnormality. The biopsy specimen showed only inflammatory changes in two patients who ultimately had proved carcinoma. One patient with multiple pulmonary infarcts due to tumor emboli showed evidence of only pulmonary infarct on biopsy. Three patients had insufficient tissue for analysis; none of the three had malignant tumor on follow-up. The sensitivity of CT-guided automated needle biopsy of the chest was 84%.
CT-guided transthoracic needle biopsy of the chest done with an automated biopsy system is safe, with a pneumothorax rate comparable to that of skinny needle aspiration. An overall accurate tissue diagnosis was made in 26 (81%) of 32 patients. Biopsies in 12 (80%) of 15 patients without carcinoma were diagnostic, which compares favorably with the reported accuracy of skinny needle aspiration.
本研究旨在确定使用自动活检系统进行CT引导下经胸针吸活检的诊断准确性及并发症发生率。
1992年2月至1994年7月期间，对32例患者连续进行了33次活检（平均年龄55±15岁；男性18例，女性14例）。使用18号针（n = 28）或20号针（n = 5）。将芯针活检标本置于10%中性福尔马林中送检病理检查。活检时未配备细胞病理学家或进行冰冻切片分析。除1例活检外，其余均由一名胸部放射科医生完成。
31例肺部活检和2例纵隔活检，病变平均大小为4.0 cm（范围1.2 - 13.0 cm）。33例活检中有3例（9%）发生活检后气胸；无一例气胸需要放置胸腔引流管。平均穿刺针数为1.3（±0.6）。30例（91%）活检获得了足够的组织用于病理评估。诊断结果包括：14例为癌，4例为急性或慢性肺炎，2例为非霍奇金淋巴瘤，卡波西肉瘤、浆细胞性肉芽肿、过敏性肺炎、卡氏肺孢子虫肺炎及纤维化各1例。1例CT显示1.5 cm结节稳定1年的患者，针吸活检发现为纤维化和慢性炎症，该结节被认为是良性的。总体而言，15例无癌患者中有12例（80%）活检具有诊断价值。3例患者获取的组织不具有潜在异常的代表性。2例最终确诊为癌的患者，活检标本仅显示炎症改变。1例因肿瘤栓子导致多发性肺梗死的患者，活检仅显示肺梗死证据。3例患者组织量不足无法分析；3例患者随访均未发现恶性肿瘤。CT引导下胸部自动针吸活检的敏感性为84%。
使用自动活检系统进行CT引导下经胸针吸活检是安全的，气胸发生率与细针穿刺抽吸相当。32例患者中有26例（81%）获得了准确的组织学诊断。15例无癌患者中有12例（80%）活检具有诊断价值，与报道的细针穿刺抽吸准确性相比具有优势。
