Morrissey B, Adams H, Gibbs A R, Crane M D
Department of Radiology, Llandough Hospital, NHS Trust, Penarth, South Glamorgan.
Thorax. 1993 Jun;48(6):632-7. doi: 10.1136/thx.48.6.632.
A number of reports of radiologically guided percutaneous biopsy of mediastinal masses have been described but techniques have varied, particularly the type of needle used. In this study mediastinal biopsies with fine aspiration needles and cutting needles have been compared, sometimes in the same patient. The results are reviewed with particular emphasis on the choice of biopsy needle and its influence on pathological diagnosis.
A retrospective review was undertaken of radiologically guided mediastinal biopsies performed between 1981 and 1991.
Sixty fine needle aspiration biopsies (FNA) and 34 Tru-Cut biopsies of mediastinal masses were performed in 75 patients with fluoroscopic or computed tomographic guidance. Overall sensitivity and specificity in terms of diagnosis of malignant disease were 90% and 100% respectively for FNA biopsies, and 96% and 100% for Tru-Cut biopsies. Diagnostic accuracy in terms of precise diagnosis of the malignant or benign nature of a mass and its origin was 77% for FNA biopsies and 94% for Tru-Cut biopsies. For FNA biopsies sensitivity and accuracy were higher for carcinomatous lesions (96% and 88%) than for noncarcinomatous lesions (81% and 69%). The only significant complication encountered was a pneumothorax following a biopsy which required intercostal drainage.
Radiologically guided percutaneous needle biopsy is a safe procedure which provides useful diagnostic information in the majority of cases. Fine needle aspiration techniques usually suffice for carcinomatous lesions but a cutting needle biopsy should be performed whenever possible when lymphoma, thymoma, or neural masses are suspected to obtain larger specimens for more accurate histological diagnosis.
已有多篇关于纵隔肿块放射学引导下经皮活检的报道，但技术各有不同，尤其是所用针的类型。在本研究中，对使用细针穿刺针和切割针进行纵隔活检进行了比较，有时是在同一患者身上。现将结果进行回顾，特别强调活检针的选择及其对病理诊断的影响。
对1981年至1991年间进行的放射学引导下纵隔活检进行回顾性研究。
在75例患者中，在荧光透视或计算机断层扫描引导下，对纵隔肿块进行了60次细针穿刺活检（FNA）和34次Tru-Cut活检。就恶性疾病诊断而言，FNA活检的总体敏感性和特异性分别为90%和100%，Tru-Cut活检分别为96%和100%。就肿块的恶性或良性性质及其起源的精确诊断而言，FNA活检的诊断准确率为77%，Tru-Cut活检为94%。对于FNA活检，癌性病变的敏感性和准确率（分别为96%和88%）高于非癌性病变（分别为81%和69%）。唯一遇到的严重并发症是活检后发生气胸，需要进行肋间引流。
放射学引导下经皮针吸活检是一种安全的操作，在大多数情况下能提供有用的诊断信息。细针穿刺技术通常足以诊断癌性病变，但当怀疑为淋巴瘤、胸腺瘤或神经源性肿块时，应尽可能进行切割针活检，以获取更大的标本进行更准确的组织学诊断。
