CT引导下经皮肺穿刺活检术非诊断性结果的影响因素  

Influencing factors of non-diagnostic findings from percutaneous computed tomography-guided transthoracic lung biopsy

作　　者：朱建彬[1] 屈耀铭 王显龙[1] 汪洋 莫建华 文海涛 林耕耘 江永焰[1] 蒋春秀[1] 温志波[1] Zhu Jianbin;Qu Yaoming;Wang Xianlong;Wang Yang;Mo Jianhua;Wen Haitao;Lin Gengyun;Jiang Yongyan;Jiang Chunxiu;Wen Zhibo(Department of Imaging Diagnostics,Zhujiang Hospital of Southern Medical University,Guangzhou 510280,China)

机构地区：[1]南方医科大学珠江医院影像诊断科,广州510280

出　　处：《中华生物医学工程杂志》2023年第1期41-50,共10页Chinese Journal of Biomedical Engineering

摘　　要：目的评估CT引导下经皮肺穿刺活检术(PCTLB)非诊断性结果的相关影响因素,并探究每个非诊断类别最终恶性病变的发生率及风险。方法收集2014年1月至2017年9月于本院影像诊断科接受PCTLB的1028例的临床、影像学特征及病理诊断(包括穿刺诊断及最终诊断)资料。非诊断性结果分为非特异性良性病变、非典型细胞和正常肺组织或组织标本不足。通过单、多因素分析寻找与非诊断性结果及非诊断结果中恶性病变相关的影响因素。结果穿刺病理结果为非诊断性结果的比例为22.9%(235/1028),最终有28.1%(66/235)病例被诊断为恶性病变,在3类非诊断性病理类别中,来源于非特异性良性病变组为37.9%(25/66)、非典型细胞组34.8%(23/66)及正常肺组织或组织标本不足组27.3%(18/66)。最终恶性病变的风险比例在非典型细胞(88.5%)组最高。很短的穿刺标本长度(0~0.1 cm)(OR=4.606,P<0.05)及怀疑为良性病变(OR=14.597,P<0.05)是非诊断性结果的独立影响因素。在非诊断性结果中,实性病灶(OR=7.430,P<0.05)、术后发生高级别肺出血并发症(OR=6.411,P=0.003)、较长的穿刺标本长度(OR=0.141,P=0.003)、病理显示存在非典型细胞(OR=61.604,P<0.05)及正常肺组织或组织标本不足(OR=4.486,P=0.002)与最终诊断为恶性病变相关。结论在PCTLB的非诊断结果中,病理显示为非典型细胞、正常肺组织或组织标本不足与最终恶性诊断相关,并且强调被归类为非典型细胞组为恶性病变的可能性最高,对怀疑为恶性病变可能时,应进行重复的PCTLB或临床影像随访。Objective To evaluate the influencing factors of non-diagnostic findings in percutaneous computed tomography-guided transthoracic lung biopsy(PCTLB),and the incidence and risk of eventual malignancy in each non-diagnostic category.Methods The clinical,imaging features and pathological diagnoses(including puncture biopsy and final diagnoses)of 1028 patients who underwent PCTLB in our Department of Imaging Diagnostics between January 2014 and September 2017 were retrieved.Non-diagnostic findings were classified as non-specific benign lesions,atypical cells,and normal lung tissue or inadequate tissue specimens.The influencing factors related to non-diagnostic findings and eventual malignancy with these non-diagnostic findings were determined via univariate and multivariate analyses.Results The proportion of non-diagnostic findings of puncture biopsy was 22.9%(235/1028).Of these,28.1%(66/235)were eventually identified as malignancy.Among the three categories of non-diagnostic findings,37.9%(25/66)were of benign lesions,34.8%(23/66)were of atypical cells,and 27.3%(18/66)were of normal lung tissue or inadequate tissue specimens.The risk ratio for eventual malignancy was highest with the findings of atypical cells(88.5%).Very short length of puncture specimen(0-0.1 cm)(OR=4.606,P<0.05)and suspected benign lesions(OR=14.597,P<0.05)were independent influencing factors of non-diagnostic findings.Among the non-diagnostic findings,solid lesions(OR=7.430,P<0.05),post-procedural higher-grade hemorrhagic complications of the lung(OR=6.411,P=0.003),longer length of biopsy specimen(OR=0.141,P=0.003),presence of atypical cells identified by pathology(OR=61.604,P<0.05),and normal lung tissue or inadequate tissue specimens(OR=4.486,P=0.002)were associated with eventual diagnosis of malignancy.Conclusion Among the non-diagnostic findings of PCTLB,pathological identification of atypical cells,normal lung tissue or inadequate tissue specimens were associated with eventual diagnosis of malignancy.It should be emphasised that atypical ce

关 键 词：体层摄影术 螺旋计算机 经皮肺穿刺活检术 非诊断结果 非典型细胞 影响因素 

分 类 号：R563[医药卫生—呼吸系统] R816.41[医药卫生—内科学]