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作 者:张旭胤 杜永浩[1] 梁挺[1] BOGALE Girma Abdeta 尚进[1] 牛刚[1] 张硕[1] ZHANG Xuyin;DU Yonghao;LIANG Ting;BOGALE Girma Abdeta;SHANG Jin;NIU Gang;ZHANG Shuo(Department of Imaging,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)
机构地区:[1]西安交通大学第一附属医院影像科,陕西西安710061
出 处:《实用放射学杂志》2023年第3期456-459,共4页Journal of Practical Radiology
基 金:陕西省重点研发计划一般项目(2020SF-104)。
摘 要:目的探讨CT引导下经皮经胸同轴肺活检非诊断性穿刺的危险因素。方法回顾性选取进行肺穿刺活检患者491例,根据病理结果将其分为诊断性穿刺组和非诊断性穿刺组,前者指病理结果为恶性和特异良性(如结核、错构瘤),后者指病理结果为非特异良性(如慢性炎症、纤维化)、异型细胞和取材不足(如肺组织、坏死)。收集可能影响穿刺活检结果的因素,包括患者特征、病灶特征、穿刺活检相关特征,使用二元Logistic回归对发生非诊断性穿刺结果的危险因素进行分析。结果共纳入437例病例,318例为诊断性穿刺组,其中恶性276例,特异良性42例,119例为非诊断性穿刺组,其中非特异良性68例,异型细胞5例,取材不足46例。多因素分析发现吸烟指数≤400年支[比值比(OR)=1.72,P=0.036]、病灶位于下叶(OR=1.78,P=0.012)、无分叶征(OR=1.75,P=0.031)、病灶大小≤22 mm(OR=1.89,P=0.030)、进针次数>1(OR=5.96,P=0.011)、有出血和/或气胸并发症(OR=2.69,P<0.001)是非诊断性穿刺的危险因素。结论吸烟指数、病灶位置和大小、病灶有无分叶、进针次数及是否有并发症与非诊断性穿刺有关,在临床决策及穿刺操作中应考虑这些因素,以减少非诊断性穿刺的发生。Objective To investigate the risk factors of nondiagnostic puncture in CT-guided percutaneous transthoracic coaxial lung biopsy.Methods A total of 491 patients with lung puncture biopsy were retrospectively selected and divided into two groups,including diagnostic puncture group and nondiagnostic puncture group according to the pathological results.The former was defined as malignancy and specific benign(such as tuberculosis,hamartoma),the latter referred to the nonspecific benign(such as chronic inflammation,fibrosis),atypical cell,and insufficient specimen(such as lung tissue,necrosis).The factors that may affect the results of puncture biopsy,including patient characteristics,lesion characteristics,and biopsy characteristics were all collected.The risk factors of nondiagnostic puncture were analyzed using binary Logistic regression.Results A total of 437 biopsy cases were included,of which 318 were diagnostic puncture group,including 276 malignancies,42 specific benign,and 119 were nondiagnostic puncture group,including 68 nonspecific benign,5 atypical cells,and 46 insufficient specimens.Multivariate analysis showed that smoking index≤400 cigarettes[odds ratio(OR)=1.72,P=0.036],lesions located in the lower lobe(OR=1.78,P=0.012),lesions without lob-ulation sign(OR=1.75,P=0.031),lesion size≤22 mm(OR=1.89,P=0.030),number of pleural passages>1(OR=5.96,P=0.011),hemorrhage and/or pneumothorax(OR=2.69,P<0.001)were risk factors of nondiagnostic puncture.Conclusion Smoking index,lesion location and size,lobulation sign,number of pleural passages and complications are associated with nondiagnostic puncture.These factors should be considered in clinical decision and puncture procedures to decrease the occurrence of nondiagnostic puncture.
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