CT与超声引导下经皮肺或胸膜病变穿刺活检的有效性和安全性比较

摘要/Abstract

摘要：

目的比较CT与超声引导下经皮肺或胸膜病变穿刺活检的有效性和安全性。方法回顾性分析2017年2月至2020年10月在湖北医药学院附属十堰市人民医院接受CT或超声引导下经皮穿刺的病灶靠近胸膜的193例肺占位患者的临床资料。根据穿刺方式将患者分为CT引导组（n=115）和超声引导组（n=78）。比较两组患者的一般临床资料、病理检查结果及穿刺成功率、并发症发生率。采用logistic回归进行单因素、多因素分析。结果CT引导组恶性肿瘤检出率（60.00%,69/115）高于超声引导组（50.00%,39/78）,但差异无统计学意义（χ²=1.89,P=0.170）。CT引导组穿刺成功率（88.70%,102/115）略低于超声引导组（93.59%,73/78）,差异无统计学意义（χ²=1.32,P=0.251）。CT引导组术后并发症发生率（18.26%,21/115）高于超声引导组（6.41%,5/78）,差异有统计学意义（χ²=5.60,P=0.018）;CT引导组气胸发生率（13.04%,15/115）高于超声引导组（3.85%,3/78）,差异有统计学意义（χ²=4.65,P=0.031）;CT引导组出血发生率（5.22%,6/115）高于超声引导组（2.56%,2/78）,差异无统计学意义（χ²=0.82,P=0.364）。CT引导组中有1例（0.87%）患者出现严重出血需要手术治疗,5例（4.35%）需要胸腔闭式引流进行治疗,超声引导组中未出现气胸或出血需要进行引流或手术治疗患者。单因素分析发现穿刺方法为影响病变-胸膜接触弧长（LPCAL）≥38 mm的患者穿刺成功率的独立危险因素（OR=7.82,95%CI为1.57~35.50,P=0.039）;多因素分析显示穿刺方法为影响LPCAL≥38 mm患者穿刺成功率的独立危险因素（OR=7.75,95%CI为1.44~41.36,P=0.042）。LPCAL≥38 mm患者中,CT和超声引导穿刺成功率分别为84.38%（54/64）、98.00%（49/50）,CT引导穿刺成功率低于超声引导,差异具有统计学意义（χ²=4.52,P=0.034）;LPCAL<38 mm患者中,CT和超声引导穿刺成功率分别为94.12%（48/51）、85.71%（24/28）,CT引导的穿刺成功率高于超声引导,但差异无统计学意义（χ²=0.71,P=0.399）。结论超声引导下经皮肺或胸膜病变穿刺活检具有诊断正确率高、并发症少等优点,其与CT引导下穿刺活检均为胸壁病变穿刺的可行方法。当LPCAL≥38 mm时,超声引导下穿刺活检可能更具优势。

关键词:肺疾病,活组织检查,针吸,体层摄影术,X线计算机,超声检查

Abstract:

ObjectiveTo compare the efficacy and safety of CT and ultrasound-guided percutaneous biopsy of lung or pleural lesions.MethodsThe clinical data of 193 patients with lung space occupying lesions near the pleura who underwent CT or ultrasound-guided percutaneous puncture in Shiyan People's Hospital Affiliated to Hubei University of Medicine from February 2017 to October 2020 were analyzed retrospectively. According to the puncture mode, the patients were divided into CT-guided group （n=115） and ultrasound-guided group （n=78）. The general clinical data, pathological examination results, puncture success rate and complication rate were compared between the two groups. Logistic regression was used for univariate and multivariate regression analysis.ResultsThe detection rate of malignant tumors in the CT-guided group （60.00%, 69/115） was higher than that in the ultrasound-guided group （50.00%, 39/78）, with no statistically significant difference （χ²=1.89,P=0.170）. The puncture success rate in the CT-guided group （88.70%, 102/115） was slightly lower than that in the ultrasound-guided group （93.59%, 73/78）, with no statistically significant difference （χ²=1.32,P=0.251）. The incidence of postoperative complications in the CT-guided group （18.26%, 21/115） was higher than that in the ultrasound-guided group （6.41%, 5/78）, with a statistically significant difference （χ²=5.60,P=0.018）. The incidence of pneumothorax in the CT-guided group （13.04%, 15/115） was higher than that in the ultrasound-guided group （3.85%, 3/78）, with a statistically significant difference （χ²=4.65,P=0.031）. The incidence rate of bleeding in the CT-guided group （5.22%, 6/115） was higher than that in the ultrasound-guided group （2.56%, 2/78）, with no statistically significant difference （χ²=0.82,P=0.364）. In the CT-guided group, 1 patient （0.87%） had severe bleeding requiring surgical treatment, 5 patients （4.35%） required closed thoracic drainage for treatment. In the ultrasound-guided group, no patients had pneumothorax or bleeding requiring drainage or surgery. Univariate analysis showed that the puncture method was an independent risk factor for the puncture success rate in patients with lesion-pleura contact arc length （LPCAL）≥38 mm （OR=7.82, 95%CI： 1.57-35.50,P=0.039）. Multivariate analysis showed that puncture method is an independent risk factor affecting the puncture success rate in patients with LPCAL≥38 mm （OR=7.75, 95%CI： 1.44-41.36,P=0.042）. Among patients with LPCAL≥38 mm, the puncture success rates of CT- and ultrasound-guided puncture were 84.38% （54/64） and 98.00% （49/50）, respectively, and the puncture success rate of CT-guided puncture was lower than that of ultrasound-guided puncture, with a statistically significant difference （χ²=4.52,P=0.034）. In LPCAL<38 mm patients, the puncture success rates of CT- and ultrasound-guided puncture were 94.12% （48/51） and 85.71% （24/28）, respectively, and the CT-guided puncture success rate was higher than that of the ultrasound-guided puncture, with a statistically significant difference （χ²=0.71,P=0.399）.ConclusionUltrasound-guided percutaneous puncture biopsy of lung or pleural lesions has the advantages of high diagnostic rate and few complications. Both ultrasound-guided and CT-guided puncture biopsy are feasible methods for puncture of chest wall lesions. When LPCAL≥38 mm, ultrasound-guided puncture biopsy may have more advantages.

Key words:Lung disease,Biopsy, needle,Tomography, X-ray computed,Ultrasonography

宋彤骏, 邓睿, 费蕾, 雷金华, 曹风军. CT与超声引导下经皮肺或胸膜病变穿刺活检的有效性和安全性比较[J]. 国际肿瘤学杂志, 2022, 49(9): 526-531.

Song Tongjun, Deng Rui, Fei Lei, Lei Jinhua, Cao Fengjun. Comparison of the efficacy and safety of percutaneous needle biopsy of pulmonary or pleural lesions guided by CT and ultrasound[J]. Journal of International Oncology, 2022, 49(9): 526-531.

图/表5

图1

图2

表1

两组近胸壁肺占位穿刺患者一般临床资料比较（例）"

基线特征	CT引导组（n=115）	超声引导组（n=78）	χ²值	P值
性别
男	69	55	2.24	0.135
女	46	23	2.24	0.135
年龄(岁)
≤60	51	32	0.21	0.647
>60	64	46	0.21	0.647
病变部位
左	61	36	0.88	0.348
右	54	42	0.88	0.348
BMI
<21	63	44	0.05	0.823
≥21	52	34	0.05	0.823
基线特征	CT引导组（n=115）	超声引导组（n=78）	χ²值	P值
吸烟史
是	56	37	0.03	0.864
否	59	41	0.03	0.864
FEV1/pred（%）
<80	43	23	1.29	0.256
≥80	72	55	1.29	0.256
FEV1/FVC（%）
<70	49	32	0.05	0.827
≥70	66	46	0.05	0.827
病灶大小（mm）
<40	55	30	1.65	0.198
≥40	60	48	1.65	0.198
LPCAL（mm）
<38	51	28	1.37	0.241
≥38	64	50	1.37	0.241

表1

变量	OR值	95%CI	P值
性别	1.62	0.70~5.28	0.428
年龄	1.53	0.41~6.34	0.339
病变部位	1.34	0.40~1.66	0.560
吸烟史	1.35	0.51~1.77	0.612
BMI	1.28	0.43~3.20	0.750
FEV1/pred	5.15	0.46~3.23	0.546
FEV1/FVC	3.39	0.55~8.13	0.694
病灶大小	7.73	0.73~6.58	0.422
穿刺方法	3.51	0.52~1.47	0.165

表2

变量	OR值	95%CI	P值
性别	1.29	0.33~6.27	0.401
年龄	1.41	0.39~7.96	0.316
病变部位	1.09	0.36~1.82	0.502
吸烟史	1.21	0.50~1.97	0.533
BMI	1.16	0.43~5.26	0.677
FEV1/pred	4.52	0.42~4.56	0.601
FEV1/FVC	3.16	0.46~9.23	0.662
病灶大小	6.48	0.68~1.01	0.127
穿刺方法	7.82	1.57~35.50	0.039

表3

参考文献19

[1]	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022[J]. CA Cancer J Clin, 2022, 72(1): 7-33. DOI: 10.3322/caac.21708. doi:10.3322/caac.21708
[2]	Faiella E, Frauenfelder G, Santucci D, et al. Percutaneous low-dose CT-guided lung biopsy with an augmented reality navigation system: validation of the technique on 496 suspected lesions[J]. Clin Imaging, 2018, 49: 101-105. DOI: 10.1016/j.clinimag.2017.11.013. doi:10.1016/j.clinimag.2017.11.013
[3]	Schneider CS, Oster RA, Hegde A, et al. Nonoperative treatment of large (5-7 cm), node-negative non-small cell lung cancer commonly deviates from NCCN Guidelines[J]. J Natl Compr Canc Netw, 2021, 20(4): 371-377. e5. DOI: 10.6004/jnccn.2021.7043. doi:10.6004/jnccn.2021.7043
[4]	Halpenny D, Das K, Ziv E, et al. Percutaneous computed tomography guided biopsy of sub-solid pulmonary nodules: differentiating solid from ground glass components at the time of biopsy[J]. Clin Imaging, 2021, 69: 332-338. DOI: 10.1016/j.clinimag.2020.07.011. doi:10.1016/j.clinimag.2020.07.011
[5]	Xu C, Yuan Q, Chi C, et al. Computed tomography-guided percutaneous transthoracic needle biopsy for solitary pulmonary nodules in diameter less than 20 mm[J]. Medicine (Baltimore), 2018, 97(14): e0154. DOI: 10.1097/MD.0000000000010154. doi:10.1097/MD.0000000000010154
[6]	Yamamoto N, Watanabe T, Yamada K, et al. Efficacy and safety of ultrasound (US) guided percutaneous needle biopsy for peripheral lung or pleural lesion: comparison with computed tomography (CT) guided needle biopsy[J]. J Thorac Dis, 2019, 11(3): 936-943. DOI: 10.21037/jtd.2019.01.88. doi:10.21037/jtd.2019.01.88pmid:31019783
[7]	Jarmakani M, Duguay S, Rust K, et al. Ultrasound versus computed tomographic guidance for percutaneous biopsy of chest lesions[J]. J Ultrasound Med, 2016, 35(9): 1865-1872. DOI: 10.7863/ultra.15.10029. doi:10.7863/ultra.15.10029pmid:27388815
[8]	邱旭龙, 李锐雄, 卢来顺, 等. 比较超声与CT引导经皮同轴穿刺活检在周围型肺肿物中的诊断价值[J]. 岭南急诊医学杂志, 2021, 26(2): 184-186. DOI: 10.3969/j.issn.1671-301X.2021.02.026. doi:10.3969/j.issn.1671-301X.2021.02.026
[9]	Park J, Park B, Lim JK, et al. Ultrasound-guided percutaneous needle biopsy for small pleural lesions: diagnostic yield and impact of CT and ultrasound characteristics[J]. AJR Am J Roentgenol, 2021, 217(3): 699-706. DOI: 10.2214/AJR.20.24120. doi:10.2214/AJR.20.24120
[10]	Zhang Y, Huang H, Cao S, et al. Clinical value of an electromagnetic navigation system for CT-guided percutaneous lung biopsy of peripheral lung lesions[J]. J Thorac Dis, 2021, 13(8): 4885-4893. DOI: 10.21037/jtd-21-395. doi:10.21037/jtd-21-395pmid:34527327
[11]	Jeon MC, Kim JO, Jung SS, et al. CT-guided percutaneous transthoracic needle biopsy using the additional laser guidance system by a pulmonologist with 2 years of experience in CT-guided percutaneous transthoracic needle biopsy[J]. Tuberc Respir Dis (Seoul), 2018, 81(4): 330-338. DOI: 10.4046/trd.2017.0123. doi:10.4046/trd.2017.0123
[12]	Cozzolino I, Ronchi A, Messina G, et al. Adequacy of cytologic samples by ultrasound-guided percutaneous transthoracic fine-needle aspiration cytology of peripheral pulmonary nodules for morphologic diagnosis and molecular evaluations: comparison with computed tomography-guided percutaneous transthoracic fine-needle aspiration cytology[J]. Arch Pathol Lab Med, 2020, 144(3): 361-369. DOI: 10.5858/arpa.2018-0346-OA. doi:10.5858/arpa.2018-0346-OApmid:31329477
[13]	Zhang P, Liu JM, Zhang YY, et al. Computed tomography-guided lung biopsy: a meta-analysis of low-dose and standard-dose protocols[J]. J Cancer Res Ther, 2021, 17(3): 695-701. DOI: 10.4103/jcrt.JCRT_1274_20. doi:10.4103/jcrt.JCRT_1274_20pmid:34269301
[14]	Drumm O, Joyce EA, de Blacam C, et al. CT-guided lung biopsy: effect of biopsy-side down position on pneumothorax and chest tube placement[J]. Radiology, 2019, 292(1): 190-196. DOI: 10.1148/radiol.2019182321. doi:10.1148/radiol.2019182321pmid:31084480
[15]	Pérez Montilla ME, Lombardo Galera S, Espejo Herrero JJ, et al. Diagnostic performance of imaging-guided core needle biopsy of the mesentery and peritoneum[J]. Radiologia (Engl Ed), 2018, 60(2): 128-135. DOI: 10.1016/j.rx.2017.12.003. doi:10.1016/j.rx.2017.12.003
[16]	Lemieux S, Kim T, Pothier-Piccinin O, et al. Ultrasound-guided transthoracic needle biopsy of the lung: sensitivity and safety variables[J]. Eur Radiol, 2021, 31(11): 8272-8281. DOI: 10.1007/s00330-021-07888-9. doi:10.1007/s00330-021-07888-9
[17]	Portela-Oliveira E, Souza CA, Gupta A, et al. Ultrasound-guided percutaneous biopsy of thoracic lesions: high diagnostic yield and low complication rate[J]. Clin Radiol, 2021, 76(4): 281-286. DOI: 10.1016/j.crad.2020.12.004. doi:10.1016/j.crad.2020.12.004pmid:33531160
[18]	Heerink WJ, de Bock GH, de Jonge GJ, et al. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis[J]. Eur Radiol, 2017, 27(1): 138-148. DOI: 10.1007/s00330-016-4357-8. doi:10.1007/s00330-016-4357-8pmid:27108299
[19]	Navin PJ, Eickstaedt NL, Atwell TD, et al. Safety and efficacy of percutaneous image-guided mediastinal mass core-needle biopsy[J]. Mayo Clin Proc Innov Qual Outcomes, 2021, 5(6): 1100-1108. DOI: 10.1016/j.mayocpiqo.2021.09.006. doi:10.1016/j.mayocpiqo.2021.09.006pmid:34877475