| ObjectiveWith the improvement of medical conditions for the whole population and the popularization of various imaging examinations,especially high-resolution low-dose spiral CT,the detection rate of pulmonary nodules is increasing,and the diagnostic demand for pulmonary nodules is also increasing.The imaging definition of pulmonary nodules is focal,quasi circular,high-density solid or sub solid lung shadows with a diameter of ≤30mm,which can be isolated or multiple,without atelectasis,hilar lymph node enlargement,and pleural effusion.At present,there are a variety of diagnostic techniques for pulmonary nodules,which can be basically divided into two inspection paths.The first is "outside to inside".At present,CT-guided percutaneous lung biopsy(or CT-guided percutaneous lung biopsy,CT-PTNB for short),which is the most widely used clinical technique,and the other is "inside to outside",that is,various bronchoscopy inspection techniques,These include the new bronchoscopy inspection technology emerging in recent years,such as virtual bronchoscopy navigation(VBN).There is currently limited research on the comparison of diagnostic value between two examination pathways.Different sizes and locations of pulmonary nodules are most suitable for which examination pathway to use.There is currently no clear comparison of diagnostic value,and further research is needed.This study analyzed the diagnostic rate,operating time,and incidence of complications of the CT-PTNB and VBN groups under different lung fields and lung nodule sizes,and compared whether the differences between the groups were statistically significant.The diagnostic value of CT-PTNB and VBN for lung nodules was analyzed and compared.Materials and MethodsThis study collected pulmonary nodules(8mm≤diameter≤30mm)screened by chest CT from December 2020 to August 2022 in The Shandong Provincial Qianfoshan Hospital and The Shandong Second Provincial General Hospital,and then accepted CT-PTNB or VBN.A total of 163 patients underwent tissue biopsy,Both groups were operated by skilled physicians.The retrospective analysis based on the collected clinical data.According to the different operating methods used,the patients were divided into CT-PTNB group and VBN group.The gender,age,lung lobe position,lung field distribution and other characteristics of patients with pulmonary nodules in this study were analyzed,and then the pathological diagnosis results of the CT-PTNB and VBN groups were analyzed,as well as the diagnostic rate,incidence of complications,localization time,total examination time,etc.under different conditions such as different lung fields and different sizes of pulmonary nodules.The differences between the groups were compared to see if they were statistically significant,Compare the value of CT-PTNB and VBN in the diagnosis of pulmonary nodules.ResultsA total of 163 cases of pulmonary nodules were included in this study.According to the different sampling methods of pulmonary nodules biopsy,the collected cases were divided into CT-PTNB group and vVBN group.The number of cases in the CT-PTNB group was 122,and the number of cases in the VBN group was 41.Statistical analysis of the two groups of cases showed that:1..In terms of gender and age,there were 73 males and 49 females in the CT-PTNB group,The age of the enrolled cases was 56.3±8.9,with an actual age range of 42-78 years.There were 23 males and 18 females in the VBN group.The age of the enrolled cases was(57.5±9.1)years old,with an actual age range of 49-75 years old.There was no statistically significant difference in age between the CT-PTNB group and the VBN group(P>0.05).2.In terms of lung lobe location,in the CT-PTNB group,57 cases had lesions located in the upper lobe,13 cases in the middle or lingual lobe,and 52 cases in the lower lobe;In the VBN group,18 cases had lesions located in the upper lobe,5 cases in the middle or lingual lobe,and 18 cases in the lower lobe;3.In terms of lung field distribution.in the CT-PTNB group,there were 32 cases in the proximal hilar area,31 cases in the middle area,and 59 cases in the peripheral area;In the VBN group,there were 11 cases in the proximal hilar area,17 cases in the middle area,and 13 cases in the peripheral area;4.In terms of overall diagnostic rate,the overall diagnostic rate of the CT-PTNB group was 89.3%(109/122),while that of the VBN group was 75.6%(31/41).There was a statistically significant difference in diagnostic rate between the two groups(P<0.05).Compared between groups,there was no statistically significant difference in the diagnostic positive rate between the CT-PTNB group and the VBN group for pulmonary nodules with a diameter>2cm(P>0.05).For pulmonary nodules with a diameter ≤2cm,there was no statistically significant difference in the diagnostic positive rate between the CT-PTNB group and the VBN group(P>0.05).It can be seen that the size of pulmonary nodules has no significant impact on the diagnostic positivity rate of CT-PTNB and VBN.5.In terms of complications.among the 122 cases in the CT-PTNB group,5 cases of pneumothorax requiring special treatment occurred.The incidence of pneumothorax requiring special treatment in CT-PTNB complications was 4.1%(5/122),while the incidence of pneumothorax in VBN complications was 4.9%(2/41);In terms of hemoptysis,2 out of 122 cases in the CT-PTNB group experienced hemoptysis,and the incidence of hemoptysis in CT-PTNB complications was 1.6%(2/122).All cases improved after symptomatic treatment such as medication or intervention,and there were no fatal cases of hemoptysis.However,there were no complications of hemoptysis in the 41 cases involved in the VBN group of this study.One case in VBN group developed transient hypoxemia during operation,which was improved after symptomatic treatment,without other serious complications such as massive hemoptysis and infection.According to the statistical results of this complication,the incidence rate of complications in the CT-PTNB group was 5.7%(7/122),while the incidence rate in the VBN group was 7.3%(3/41).There was no statistically significant difference between the two groups(P>0.05);6.The required localization time for the CT-PTNB group was 8.7±2.6 minutes,and for the VBN group was 6.5 ± 2.3 minutes.The difference between the two was statistically significant(P<0.001).The total operating time of the CT-PTNB group was 15.1±1.8 minutes,while the total operating time of the VBN group was 12.7±1.5 minutes.The difference between the two was statistically significant(P<0.001).VBN can shorten the operating time and improve sampling efficiency.Conclusion1.CT-PTNB has a higher overall diagnostic rate in diagnosing pulmonary nodules than VBN;2.There was no significant difference in the incidence of complications between CT-PTNB and VBN;3.CT-PTNB requires a longer operating time than VBN,in other words,VBN can reduce the operating time(positioning time and total examination time).For patients with insufficient tolerance,VBN can be given priority consideration;4.CT-PTNB currently has higher diagnostic value and accessibility for pulmonary nodules than VBN. |
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