The Research On Diagnostic Efficacy Of Ultrasound-guided Percutaneous Needle Biopsy For Peripheral Pulmonary Lesions

Objective: To evaluate the diagnostic efficiency of ultrasound-guided percutaneous needle biopsy(US-PNB)for peripheral pulmonary lesions according to the intention-to-diagnose principle.Materials and Methods: A retrospective analysis of 957 patients with peripheral pulmonary lesions of US-PNB admitted to the First Affiliated Hospital of Guangxi Medical University from January 2017 to December 2019 was performed.(1)The results of US-PNB and clinical outcomes of the studied patients were statistically analyzed.(2)Diagnostic efficacy includes diagnostic accuracy,sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV).With the final clinical diagnosis as the gold standard,the total diagnostic accuracy,sensitivity,specificity,PPV and NPV of peripheral pulmonary lesions in US-PNB were counted according to the principle of intention diagnosis.The ROC curve of the accuracy rate of US-PNB in the diagnosis of peripheral pulmonary lesions was drawn,and the area below the ROC curve was calculated.(3)(1)957 biopsy procedures were divided into two groups according to lesion sizes: ≤ 35 mm group,543 cases and > 35 mm group,414 cases,and the differences in diagnostic accuracy,sensitivity,specificity,PPV,and NPV between these two groups were compared.(2)According to different types of puncture needles,957 biopsy procedures were divided into two groups: 16 G group,100 cases and 18 G group,857 cases,and the differences in diagnostic accuracy,sensitivity,specificity,PPV,and NPV between these two groups were compared.(3)According to different puncture times,957 biopsy procedures were divided into three groups: puncture times ≤2 groups,251 cases,puncture times 3 groups,511 cases,and puncture times ≥4 groups,195 cases.The diagnostic accuracy,sensitivity,specificity,PPV and NPV among these three groups were compared.Results:(1)Among the 957 cases that histopathological diagnosed by US-PNB,50.9%(487/957)were malignant lesions,43.8%(419/957)were benign lesions,and 5.3%(51/957)were unidentifiable lesions.The final clinical diagnosis was 59.4%(568/957)of malignant lesions and 40.6%(389/957)of benign lesions.(2)The diagnostic accuracy,sensitivity,and specificity of US-PNB for peripheral pulmonary lesions were 89.2%(854/957),85.4%(485/568)and 94.9 %(369/389),respectively,and the PPV and NPV were99.6%(485/487)and 88.1%(369/419),respectively.The ROC curve diagnostic model of US-PNB for peripheral pulmonary lesions was drawn,and the AUC value was 0.903(95%,CI: 0.87-0.933),which indicating that US-PNB has high diagnostic value for peripheral pulmonary lesions.The complication rates of hemoptysis,pneumothorax(symptomatic only),and the need for closed thoracic drainage were 5.8%,1.2%,and 0.3%,respectively(3)(1)The diagnostic accuracy,sensitivity,specificity,PPV,and NPV for lesions that measured ≤35mm were 90.1%(489/543),83.9%(219/261),95.8%(270/282),99.6%(219/220),and 91.5%(270/295),respectively;while the diagnostic accuracy,sensitivity,specificity,PPV,and NPV for lesions that measures > 35 mm were88.2%(365/414),86.6%(266/307),92.5%(99/107),99.6%(266/267),and79.8%(99/124),respectively.The diagnostic efficacy of these two groups was compared.The NPV of the group with lesions that measures ≤35mm was statistically significant higher than the lesions that measures >35 mm(P=0.001).However,the differences in the diagnostic accuracy,sensitivity,specificity and PPV between these two groups had no statistical significance(P>0.05).(2)The diagnostic accuracy,sensitivity,specificity,PPV,and NPV of the 16 G group were 94.0%(94/100),90.8%(59/65),100%(35/35),100%(59/59),and 100%(35/35),respectively,while the diagnostic accuracy,sensitivity,specificity,PPV,and NPV of the 18 G group were 88.7%(760/857),86.6%(426/503),94.4%(334/354),99.5%(426/428),and 87.2%(334/383),respectively.The diagnostic efficacy of these two groups was compared and the NPV of the 16 G group was statistically significantly higher than that of the 18 G group(P=0.023),while there were no significant differences in the diagnostic accuracy,sensitivity,specificity,and PPV between the two groups.(3)The diagnostic accuracy,sensitivity,specificity,PPV and NPV of the group with puncture times ≤2were 88.5%(222/251),83.5%(111/133),94.1%(111/118),100%(111/111)and89.5%(111/124),respectively.The diagnostic accuracy,sensitivity,specificity,PPV and NPV of the group with puncture times of 3 were 89.6%(458/511),85.2%(253/297),95.6%(205/214),99.2%(253/255)and 88.4%(205/232),respectively.The diagnostic accuracy,sensitivity,specificity,PPV and NPV of the group with puncture times ≥4 were 89.2%(174/195),87.7%(121/138),93.0%(53/57),100%(121/121)and 84.1%(53/63),respectively.There was no significant difference in the diagnostic efficacy among this three groups(P >0.05).Conclusion:(1)US-PNB for peripheral pulmonary lesions have the advantages of high diagnostic efficacy,easy operation and safety.(2)peripheral pulmonary lesions that measured ≤ 35 mm had higher NPV when performing US-PNB compared with those lesion that measured > 35 mm.(3)compared with18 G needle biopsy,16 G needle for US-PNB of peripheral pulmonary lesions had a higher NPV.Objective: To explore the risk factors for the failure of ultrasound-guided percutaneous needle biopsy for peripheral pulmonary lesions.Materials and Methods: A total of 957 patients with US-PNB for peripheral pulmonary lesions who underwent ultrasound examinations in the Department of Ultrasound of the First Affiliated Hospital of Guangxi Medical University from January 2017 to December 2019 were retrospectively analyzed.According to the final clinical diagnosis results,the patients were divided into successful diagnosis group and failure diagnosis group.Univariate and multivariate logistic regression analysis were used to analyze the gender,age,history of previous malignant tumors,smoking history,lesion size,type,location,nature of the lesion,patient’s position,biopsy needle type,puncture times,and puncture angle to determine the risk factors for diagnostic failure of US-PNB for peripheral pulmonary lesions.Results:(1)Among the 957 cases of US-PNB,there were 52.0%(498/957)malignant lesions,43.8%(419/957)benign lesions,and 4.2%(40/957)unidentifiable lesions.The final clinical diagnosis was malignant in 59.4%(568/957)and benign in 40.6%(389/957).(2)Univariate analysis showed that smoking history(yes,no),biopsy needle(16G,18G),and clinical final diagnosis results(benign,malignant)had effects on the diagnostic failure of US-PNB for peripheral pulmonary lesions(P < 0.05).Binary logistic regression analysis showed that smoking history(OR 1.78,95% CI: 1.132 ~ 2.784),18 G biopsy needle(OR 2.97,95% CI: 1.059 ~ 8.303),and malignant lesions(OR 2.72,95% CI: 1.625 ~ 4.553)were risk factors for the diagnostic failure of US-PNB for peripheral pulmonary lesions.Conclusion: Smoking history,18 G biopsy needle and malignant lesions are the related factors affecting the successful diagnosis of US-PNB for peripheral pulmonary lesions.Understand the risk factors of diagnostic failure can help reduce the diagnostic failure rate and improve the diagnostic success rate.Objective: To investigate the predictive factors of US-PNB for peripheral pulmonary lesions that obtain non-diagnostic results and ultimately be diagnosed as malignant lesionsMaterials and Methods: A total of 308 cases of non-diagnostic results of US-PNB for peripheral pulmonary lesions at the First Affiliated Hospital of Guangxi Medical University from January 2017 to December 2019 were studied.When no malignant cells are found and specific benign diagnosis cannot be made,it is defined as non-diagnostic results.According to the final clinical diagnosis,the non-diagnostic results were divided into benign group and malignant group.Univariate and multivariate Logistic regression were used to analyze the non-diagnostic results of peripheral pulmonary lesions of US-PNB and its independent risk factors for final diagnosis of malignant.Results: There were 306 patients(male : female,226 : 84;Age 15-79 years old,mean ± standard deviation : 32.2 ± 16.9),308 biopsies of non-diagnostic results,and clinical final diagnosis of malignant 78 cases(25.3%,78/308).In the risk prediction analysis of malignancy with non-diagnostic results,the following factors were associated with the risk of malignancy with the final diagnosis :(1)large lesions(≥38.8mm)(OR 1.025,95% CI 1.007-1.043,P=0.005);(2)mixed lesions(OR 2.321,95% CI 1.057-4.712,P=0.035);(3)insufficient tissue(OR 6.837,95%CI3.210-14.563,P<0.001);(4)typical hyperplasia(OR 34.421,95% CI 3.959-299.263,P=0.001).A total of 30.8%(24/78)of the non-diagnostic results of final diagnosis of malignant tumors with the repeated biopsy,other biopsy methods or clinical imaging follow-up were performed with repeated biopsy,and 91.7%(22/24)of them confirmed the final diagnosis during the second repeated biopsy.59.0%(46/78)received other biopsy methods.Conclusion: The related factors affecting the risk of malignancy in the final diagnosis of US-PNB for peripheral pulmonary lesions with non-diagnostic results are large lesions(≥ 38.8 mm),mixed lesions on CT,and insufficient tissue or dysplasia on pathology.25.3% of non-diagnostic findings eventually diagnose malignancy,and when histopathology suggests dysplasia,the risk of malignancy is high,and repeated biopsy or other modalities should be taken to confirm the final diagnosis.