| Objective CT guided percutaneous transthoracic needle biopsies(PTNB)is an important tool for the diagnosis of lung diseases.Hemorrhage is the second common complication of percutaneous transthoracic needle biopsies,and there is no effective mean to prevent it at present.Contrast-enhanced computed tomography(CECT)has advantage of reflecting blood supply of lesions and helping vascular imaging,which may be potential to reduce hemorrhage complicating needle biopsy.There was no reliable and large sample research evaluating whether CECT could reduce hemorrhage,therefore we conducted the study to analyse relationship between CECT and hemorrhage.Method Retrospectively collected clinical and imaging data of 1370 patients underwent PTNB in Department of respiration,Nanjing General Hospital of the PLA,during November 2011 and February 2016.49 patients were excluded to avoid the effect of puncturing the same lesion at different time on bleeding,as well as 50 patients with incomplete data,and finally enrolled 1271 patients.1282 operations were performed in this study as a result of 11 patients were punctured at different lesions(two times).Of 1282 biopsies,555 underwent CECT and 727 underwent non-contrast CT.Factors associated with hemorrhage were determined by univariate and multivariate analysis,and hemorrhage rate was compared between two groups.To reduce bias of retrospective research,propensity score matching analysis was futher performed.Results Hemorrhage rate in CECT and non-contrast CT was 16.4%(91/555)and 23.1%(168/721),respectively,which was statistical significant(p=0.003).Multivariate logistic regression analysis indicated that CECT was significantly associated with hemorrhage(OR=0.671,95%CI:0.499-0.902,p=0.008).The longest diameter of lesion and the puncture depth were negatively correlated with hemorrhage,the smaller diameter(OR=0.990,95%CI:0.983-0.997,P=0.005),and the longer puncture depth(OR=1.017,95%CI:1.009-1.025,P=0.000),the higher the hemorrhage rate.In addition,supine position and number of puncture≥2 were independent risk factor for hemorrhage(P<0.05).To reduce bias,propensity score matching was performed and revealed that incidence of hemorrhage in CECT was lower than non-contrast CT,either at proportion of 1-to-1(p=0.039),or 1-to-2(p=0.028),or 1-to-3(p=0.013).Conclusion CECT has protective effect on hemorrhage complicating PTNB.CECT examination before needle lung biopsy is necessary and may effectively reduce postoperative hemorrhage rate.Chapter Ⅱ Diagnostic Value of Repeat Computed Tomography-Guided Percutaneous Cutting Needle Biopsy for Inconclusive Lung LesionsObjective The malignant pathological results after biopsy could help doctors to quickly identify the nature of lesion,but if the biopsy pathology is benign and lack of specificity,other examination or biopsy was often needed to judge the nature of lesion.To evaluate the value of PTNB for lung lesions when it was impossible to make determined diagnoses based on initial biopsy results,we conducted the study.Methods 1803 cases underwent PTNB during January 2011 and February 2015 were reviewed,and 39 cases through repeat biopsy for determined diagnoses were enrolled.Pathological finding and biopsy image for each patient at initial and repeat biopsy were compared.Medical charts and data regarding the biopsy procedure were collected.Results There were 31 male patients and 8 female patients,with a median age of 66 years.The median diameter of the 39 patients was 50.5mm.There were 17 upper lobe lesions,15 lower lobe lesions,and 7 middle lobe lesions.On the CT image of the chest,8 were necrotic,7 were cavitary,9 were around the atelectasis around the lesion,and the other 15 were mainly mixed lesions.Of 39 patients,28 with initial benign pathological finding obtained malignant pathological results through repeat puncture biopsy,including 13 cases of squamous cell carcinoma of the lung,1 cases of salivary adenocarcinoma,11 cases of lung adenocarcinoma,1 cases of small cell lung carcinoma,1 cases of diffuse large B cell carcinoma and 1 cases of mesothelioma;the other 11 cases with benign pathological result at two biopsies,8 were finally diagnosed as benign,and 3 were turned out to be malignant.Thus,92.3%(36/39)were definitely diagnosed by repeat PTNB.False negative rate was down more than 10 times from 79.5%(31/38)to 7.7%(3/39)by repeat biopsy.No significant difference of the needle depth,the puncture angle and the number of specimens was observed between initial and repeat puncture(P>0.05).However,reviewing puncture images of two punctures,the needle tips of the initial and repeat biopsy were found to be different.There was no significant difference in the incidence of pneumothorax and hemorrhage after two punctures(P=0.631).Conclusion For indeterminate lesions,repeated CT guided PTNB is an important diagnostic tool.Repeated PTNB may reduce false negative rate and improve the diagnostic efficiency. |
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