The Research And Strategy Based On Improving Diagnostic Yield And Safety Of Ultrasound-guided Percutaneous Biopsy For Pulmonary Lesions

Based on improving the diagnostic yield and safety of ultrasound-guided percutaneous biopsy for pulmonary lesions,three parts were designed in this study.Part 1 Ultrasound-guided percutaneous core needle biopsy for peripheral pulmonary lesions:diagnostic yield,complications and influence factorsPurpose To evaluate diagnostic yield and safety of ultrasound-guided needle biopsy in the diagnosis of peripheral pulmonary lesions(PPLs),and the influence factors of diagnostic yield and safety.Methods 1005 patients who received percutaneous biopsy for PPLs from 2014 to 2020 were included.Multivariate logistic regression analysis was performed to explore the influence factor of diagnostic yield and safety.Results Confirmed pathological diagnosis was achieved in 889 cases;the diagnostic yield was 88.5%(889/1005).Multivariate logistic regression analysis revealed that biopsy needle size(P=0.042),PPLs located in the left lower lobe(P=0.046)and the right lower lobe(P=0.010)were independent factors of diagnostic yield.The overall complication rate was 8.7%(87/1005).Multivariate logistic regression analysis revealed that lesion diameter(P=0.002)and number of needle passes(P=0.047)were independent influence factors of post-procedure complications.Conclusion Ultrasound-guided percutaneous biopsy is a feasible and safe technique for PPLs.Needle size and PPLs located in lower lobe of lung are independent influence factors of diagnostic yield.Lesion diameter and number of needle passes were independent influence factors of post-procedure complications.Part 2 The clinical value of contrast-enhanced ultrasound for guiding biopsy of peripheral pulmonary lesionsPurpose To explore the diagnostic yield and safety of contrast enhanced ultrasound(CEUS)-guided percutaneous core needle biopsy for PPLs based on propensity score matching(PSM)analysis.Methods Clinical data of 129 patients who received CEUS-guided percutaneous biopsy and 286 patients who received baseline ultrasound(BUS)-guided percutaneous biopsy for PPLs from 2014 to 2020 were retrospectively analyzed.PSM was used to match the patients receiving CEUS-guided biopsy and BUS-guided biopsy in a ratio of 1:1.After PSM,120 patients receiving CEUS-guided biopsy and 120 patients receiving BUS-guided biopsy were obtained,which were included in the study.Results Before PSM,diagnostic yield was 96.1%in CEUS-guided group and 91.6%in BUS-guided group.There was no significant difference in diagnostic yield between two groups(P=0.095).Before PSM,the incidence of complications was 7.0%in CEUS guided-group and 7.3%in BUS-guided group.There was no significant difference in complications between two groups(P=0.894).After PSM,diagnostic yield was 96.7%in CEUS-guided group and 90.0%in BUS-guided group.Diagnostic yield was significantly higher in CEUS-guided group than in BUS-guided group(P=0.038).After PSM,the incidence of complications was 7.5%in CEUS guided-group and 5.8%in BUS-guided group.There was no significant difference in complications between two groups(P=0.605).Conclusion CEUSguided percutaneous biopsy is an effective and safe technique for the diagnosis of PPLs.PSM analysis showed that CEUS-guided percutaneous biopsy could improving diagnostic yield compared with BUS-guided biopsy.Part 3 The value of ultrasound-CT fusion in percutaneous biopsy for peripheral pulmonary lesionsPart 3.1 The accuracy and repeatability of ultrasound-CT fusion in percutaneous biopsy for peripheral pulmonary lesions:a phantom studyPurpose Based on the phantom study,this study was aimed to investigate the accuracy and repeatability of ultrasound-CT fusion in percutaneous biopsy for peripheral pulmonary lesions.Methods A phantom containing 10 simulated lesions was used to conduct percutaneous needle biopsy experiments under the guidance of ultrasound-CT image fusion.Phantom experiments were carried out according to the following instructions:(1)Two operators(A and B)independently perform percutaneous biopsy for ten simulated lesions under the guidance of ultrasound-CT image fusion;(2)Two operators repeated the experiments after a week.The success rates of biopsy were recorded.The inter-observer agreement and intra-observer agreement were estimated by Kappa value.Results The success rates of A and B were 90.00%(18/20)and 85.00%(17/20),respectively.There was no significant difference in the biopsy success rate between the two operators(P=0.50).The inter-operator and intra-operator repeatability were good(Kappa=0.773,P=0.016).Conclusion Ultrasound-CT image fusion-guided percutaneous biopsy had high biopsy success rate,good inter-observer and intra-operator agreement.Ultrasound-CT image fusion-guided percutaneous biopsy for PPLs was feasible in phantom study.Part 3.2 The clinical value of ultrasound-CT fusion guidance in percutaneous biopsy for peripheral pulmonary lesionsPurpose To investigate the clinical value of ultrasound-CT image fusion guidance in percutaneous biopsy for PPLs.Methods 52 patients who received ultrasound-CT fusion-guided percutaneous biopsy for PPLs that could not be clearly displayed on ultrasound from October 2018 to November 2019 were included.Besides,52 patients who received CT-guided percutaneous biopsy for PPLs during the same period were randomly selected as the control group.The difference of diagnostic yield and incidence of complications between these two groups were compared.Results The diagnostic yield of ultrasound-CT fusion-guided group was 90.4%(47/52),and that of CT-guided group was 96.2%(50/52).There was no significant difference in diagnostic yield between these two groups(P=0.240).The incidence of post-procedure complication in ultrasound-CT fusion-guided group was 7.7%(5/52),and that of CTguided group was 25.0%(13/52).The incidence of complications in the CT-guided group were significantly higher than that of the ultrasound-CT image fusion-guided group(P=0.017).Conclusion Ultrasound-CT fusion-guided percutaneous core needle biopsy is an effective and safe diagnostic procedure for PPLs,with high diagnosis yield and low complication rate.Ultrasound-CT fusion might be a useful technique for the biopsy of PPLs that could not be displayed by ultrasound.