| Background:Lung cancer, one of the leading causes of malignant tumors incidence and mortality worldwide, is increasing year by year. There are about 1.6 million new diagnosed lung cancers, accounting for 13% of malignant tumors, and 1.4 million of them died, accounting for 23% of patients died of malignant tumors. Reports revealed that five-year survival rate of patients with lung cancer was below 20%. Lung cancer is one of the most harmful disease to human health, once lung shadow found, it makes sense to diagnose biopsy as soon as possible. Nowadays, histopatholgy means to diagnosticlung cancer include CT-guided percutaneous needle biopsy, transbronchial lung biopsy, endobronchial ultrasound-guided transbronchial needle aspiration, transpleural thoracoscopy and so on. Because of high sensitivity, little trauma, low expense, short length of stay, CT-guided percutaneous needle biopsy has been widely used, and biopsy means countribute to diagnosis of lung cancer more and more with the widespread of CT. Pneumothorax and pulmonary hemorrhage are two of the most common complications. Many researchs reported the risk factor of pneumothorax rate and hemorrhage, mainly including lesion size, length of intrapulmonal biopsy path, experience in operating, COPD and number of pleural needles. However, results vary in different studies, lacking specific explanations to these differences. Statistical difference in all researches lacks powerful convince because of the small sample size.Objective: The purpose of this study was to discuss the diagnostic value of CT-guided percutaneous needle biopsy of lung cancer and identify the risk factors of complications, by retrospectively collecting and analyzing the data from 623 consecutive CT-guided core needle lung biopsies. The results of our study may contribute to decreasing or avoiding unnecessary complications and providing better guidance to clinical practice.Subjects and Methods; We collected patients’ clinical data retrospectively, in department of respiratory medicine in Third Military Medical University Xin Qiao hospital from Jan. 2010 to Dec. 2012, with diagnosis of lung cancer by the way of CT-guided percutaneous coaxial cutting needle biopsies. Patients were divided into groups by age, lesion size, the depth of needle, puncture needles, operating experience,COPD. R×C chi-square test was used to compare the differences between groups to discuss the clinical value of this means and the risk factors of pneumothorax and hemoptysis.Results:1. Among 623 cases of CT-guided percutaneous coaxial cutting needle biopsies, 618 cases were diagnosed as malignant lung tumors, with a sensitivity of 99.2%.2.The cases recruited were divided by age : age years<30, 30-40, 40-50, 50-60, 60-70, 70-80 with diagnostic sensitivity of 100%, 100%, 98%, 100%, 99%,100%,100% respectively. No significant differences between groups(P=0.56).3. The cases recruited were divided by lesion size: diameter of lesions≤2cm, 2-3cm, 3-5cm, 5-7cm,>7cm with diagnostic sensitivity of 98%, 100%, 100%, 100%,98% respectively. No significant differences between groups(P=0.07).4. The cases recruited were divided by the depth of needle: depth of needle≤3cm, 3-6cm, 6-9cm, >9cm, with diagnostic sensitivity of 99%, 99%, 99%, 100% respectively. No significant differences between groups(P=0.79).5. Among 623 cases recruited, 387 were diagnosed definitely by the means of CT-guided percutaneous lung biopsy without transbronchial lung biopsy, accounting for 62% of all biopsy cases.6. Among 623 cases recruited, 618 were diagnosed as malignant tumors. Pathological classifications were adenocarcinoma(n=378), squamous carcinoma(n=166), small cell lung cancer(n=30), undifferentiated cancer(n=18), adenosquamous carcinoma(n=6), sarcomatoid carcinoma(n=3), leimyosarcoma(n=2), neuroendocrine(n=2), low differentiated carainoid(n=1), cribriform carcinoma(n=1), malignant lymphoma(n=1) and metastatic renal cell carcinoma(n=1)respectively. Anthor 5 patients had an initial diagnosis of chronic inflammation according to their pathological feature of lung punctures. Their definite diagnosis were lung squamous cell carcinoma(n=3), adenocarcinoma(n=1) and small cell carcinoma(n=1).7. The risk factors of pneumothorax are diameter of lesions≤2cm(P=0.006), number of pleural needles ≥3(P=0.025), depth of needle>3cm(P=0.044), and inadequate experience in operating(P=0.003) and with a comorbidity of COPD(P=0.036).8. The risk factors of hemorrhage are diameter of lesions≤2cm(P=0.031), number of pleural needles ≥3(P=0.015), depth of needle >3cm(P=0.018), and inadequate experience in operating(years to operate ≤3)(P=0.014).Conclusion:1. CT-guided percutaneous lung biopsy, with high sensitivity of 99.2% and no influence of age, lesion size, lesion depth, is of high clinical application value and is an effective means to diagnose lung cancer with a wide crowd.2. CT-guided percutaneous lung biopsy can be used as an effective supplementary means for patients who can’t be diagnosed by transbronchial lung biopsy.3. CT-guided percutaneous lung biopsy can not only diagnoses clinical usual pathological type precisely, but some infrequent malignant tumors of lung.4. The risk factors of pneumothorax are diameter of lesions≤2cm, number of pleural needles ≥3, depth of needle>3cm, and inadequate experience in operating(operating experience ≤3 years) and with a comorbidity of COPD.5. The risk factors of hemorrhage are diameter of lesions≤2cm, number of pleural needles ≥3, depth of needle >3cm, and inadequate experience in operating(operating experience ≤3 years). |
PDF Full Text Request