CT-guided Percutaneous Lung Biopsy For The Diagnostic Value Of Lung Lesions And Analysis Of Risk Factors For Complications

Objective:To explore the diagnostic value of CT-guided percutaneous lung biopsy of lung lesions,and to analyze the independent risk factors affecting the incidence of different complications.Materials and Methods:A total of 605 patients with CT-guided percutaneous pulmonary biopsy and complete clinical data were retrospectively collected.All patients were confirmed to have lung lesions by chest plain scan and enhanced CT examination,which could not be clearly diagnosed by conventional imaging examination and bronchoscopy,and there were no contraindications for lung puncture.The location and size of the lesion,the length of the needle through the lung tissue,and the pathological type of the lesion were recorded.The lesions were divided into subpleural group and non-pleural group according to the location.According to the presence or absence of complications,they were divided into pneumothorax group,pulmonary hemorrhage group,pneumothorax and pulmonary hemorrhage group and normal group,and the incidence of each complication was calculated.The risk factors affecting the incidence of different complications were analyzed.χ~2test and Fisher’s exact probability method were used to compare the count data between groups,and t test was used to compare the measurement data between groups.Variables with significant differences between the groups were included in the Logistic multivariate regression analysis model to obtain independent risk factors for each complication.Results:Among the 605 patients,590 were successfully punctured and pathologically reported.The success rate of puncture and sampling was 97.5%.The distribution of lesions:135 cases(22.8%)of the upper and middle lobe of the right lung,165 cases(28.0%)of the right lower lobe,119 cases(20.2%)of the left upper lobe,and 171 cases(29.0%)of the left lower lobe.Lesion size distribution:107 cases in the group with the largest diameter of the lesion<2cm;148 cases in the 2-3cm group;192 cases in the 3-5cm group and 143 cases in the group with the largest diameter of the lesion>5cm.The length distribution of the puncture needle through the lung tissue:51.9%in 0cm group,5.9%in<1cm group,30.3%in 1-3cm group,10.3%in 3-5cm group and 1.5%in>5cm group.There were 395 cases(66.9%)of malignant lesions,112 cases(19.0%)of benign tumors,and 83 cases(14.1%)of inflammatory lesions.Among 590 patients,199 cases(33.7%)had pneumothorax,164 cases(27.8%)with pulmonary hemorrhage,and 63 cases(10.7%)had both pneumothorax and pulmonary hemorrhage.The independent risk factors that affect the incidence of pneumothorax in the subpleural group is the size of the lesion(P=0.002).The independent risk factors affecting the incidence of pneumothorax of the non-subpleural group are:plain CT value of the puncture needle travel area(P=0.035),the length of the puncture needle through the lung tissue(P=0.003),and the thickness of the puncture needle through the chest wall(P=0.020).The independent risk factors that affect the incidence of pulmonary hemorrhage in the non-subpleural group are:the length of the puncture needle passing through the lung tissue(P=0.000),the difference between enhanced and plain CT value of the puncture needle travel area(P=0.001),the size of the lesion(P=0.034),and the patient’s position(P=0.014).The length of the puncture needle passing through the lung tissue(P=0.000)and the difference between enhanced and plain CT value of the puncture needle travel area(P=0.000)are independent risk factors that affect the simultaneous occurrence of pneumothorax and pulmonary hemorrhage.Conclusion:CT-guided percutaneous lung biopsy is a safe and effective diagnostic method,which of high diagnostic value for lung-occupying lesions,and can be used for qualitative diagnosis of the lesions to further guide clinical treatment.The length of the puncture needle passing through the lung tissue is an independent risk factor that affects the common non-subpleural group pneumothorax,pulmonary hemorrhage,combined pneumothorax and pulmonary hemorrhage.The difference between enhanced and plain CT value of the puncture needle travel area is an independent risk factor affecting the complications of pulmonary hemorrhage,combined pneumothorax and pulmonary hemorrhage in the non-subpleural group.