| ObjectivesTo explore the diagnostic value and security of CT-guided percutaneous needle lungbiopsy(PTNB)for ground-glass opacity(GGO)pulmonary lesions and analyze its influence factors.To explore the value of MSCT signs of ground glass nodules in the differentiation of benign and malignant.Methods81 cases of GGO were collected from January 2015 to January 2016 in our hospital,and all of them underwent CT guided PTCB.According to nodule size,GGO nature,location,distance between the lesions and plura(DLP),and biopsy method,GGO lesions were divided into different groups,analyze the diagnostic accuracy,sensitivity,specificity,complactions and related factors.The imaging stata of GGO lesions were collected,including nodule nature(pGGO or Mggo),shape(circle,oval or irregular),border(burr,leaves or spine),interface(clear or fuzzy),internal structure(cavitation or air-filled bronchi),the change of adjacent structure(vascular cluster or pleura indentation),etc.ResultAll 81 cases got enough tissue specimen for pathological examination in one time,the success rate is 100%.The number of true positive lesions is 47,the proportion is about 58.0%,including adenocarcinoma31 cases,bronchoalveolar carcinoma12 cases,atypical adenomatous4 cases;The number of negative positive lesions is 26,the proportion is about 32.1%,includinginflammation 9 cases,tuberculosis 6 cases,organized pneumonia5 cases,hamartoma4 csaes,and pneumorrhagia2 cases.False negative lesions8 cases,all were adenocarcinoma.The overall diagnostic accuracy,the sensitivity,specicity,false positiverate,false negative rate,positive and negative predictive values were 90.1%,85.5%,100%,0%,14.5%,100%,76.5%,respectively.The overall incidence of complcations was 49.4%,7 cases(8.6%)got treatment in intraoperative or postoperative,and no serious complations.The lesionsdiameter≦1cm group(n=27),the diagnostic accuracy,sensitivity and the incidence of complcations were 88.9%,86.2% and 62.9%,respectively.The lesions diameter1-2cm group(n=36),the diagnostic accuracy,sensitivity and the incidecne of complcations were92.6%,88.9%,47.2%,respectively.The lesionsdiameter≥2cm group,the diagnostic accuracy,sensitivity,and the incidence of complications were 94.4%,92.9% and 33.3%,respectively.The pGGO group(n=35),the diagnostic accuracy,sensitivity,and the incidence of complications were 88.5%,80.9% and 57.1%,respectively.The mGGO group(n=46),the diagnostic accuracy,sensitivity,and the incidence of complications were 91.3%,88.2% and 43.5%,respectively.The DLP>1cm group(n=43),the diagnostic accuracy,sensitivity,and the incidence of complications were 90.7%,85.7% and 51.2%,respectively.The DLP≦1cm group(n=38),the diagnostic accuracy,sensitivity,and the incidence of complications were 89.5%,91.3% and 46.4%,respectively.Lesions located in the upper lobe(n=38),the diagnostic accuracy,sensitivity,and the incidence of complications were 97.3%,96.2% and 44.7%,respectively.Lesions located in the middle lobe(n=10),the diagnostic accuracy,sensitivity,and the incidence of complications were 80%,71.4% and 40%,respectively.Lesions located in the upper lobe(n=33),the diagnostic accuracy,sensitivity,and the incidence of complications were 84.8%,77.3% and 57.5%,respectively.Soft biopsy needle(single stitch)(n=30),the diagnostic accuracy,sensitivity,and the incidence of complications were 86.7%,82.6% and 40%,respectively.Coaxial trocar(the biopsy gun)(n=51),the diagnostic accuracy,sensitivity,and the incidence of complications were 92.1%,92.2% and 54.9%,respectively.The nodule nature(χ~2=5.24,P=0.022),interface(χ~2=5.01,p=0.025),shape(χ~2=15.03,P=0.000),burr sign(χ~2=5.30,P=0.021),lobulation sign(χ~2=10.235,P=0.001)and pleural indentation(χ~2=10.235,P=0.001)of the lesions were statistically significant difference betweenbenign and malignant GGOs.The gender and CT findings of air bronchogram s(χ~2=0.198,P=0.656),ovule sign(χ~2=1.784,P=0.338)were no significant difference between benign and malignant GGOs(P>0.05).In all 81 cases,the incidence of pneumothorax,pulmonary hemorrhage and hemoptysis/sputum were 18(22.2%),19(23.4%)and 10(12.3%)cases,respectively.Associations among nodal diameter,DLP,angle of needle-pleural,number of adjust needle,etc with pneumothorax,pulmonary hemorrhage and haemoptysis have been analyzed.Selected relevant factors and performed a logistic regression analysis,we found negative correlation between pneumothorax and DLP,positive correlation between needle-pleural angle and pneumothorax;positive correlation between Pulmonary hemorrhage and DLP/ the frequency of adjusting needle;positive correlation between haemoptysis/sputum blood and the frequency of adjusting needle.Conclusion1.CT-guided percutaneous needle aspiration biopsy(PTNB)is of higher accuracy,sensitivity,specifcity and high safety in the diagnosis for ground-glass opacity(GGO)pulmonary lesions;and the accuracy has nothing to do with puncture method.The common complications including pneumothorax,pulmonary hemorrhage and haemoptysis;serious complation israre.2.GGO signs of spiculation,lobulation,pleural indention suggest a higher possibity of malignant;bigger diameter and more solid elements suggest ahigher risk of malignant.3.The DLP,the puncture needle-pleural angles,andthe needle number are related to the incidence of complaitons.The nodule size,location,depth of punctureare not related to the incidence of complaitons... |
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