The Clinical Value Of Percutaneous Contrast-enhanced Pulmonary Pleural Biopsy Guided By Contrast-enhanced Ultrasound(CEUS)

Objective To investigate the clinical value of percutaneous contrast-enhanced pulmonary pleural biopsy guided by contrast-enhanced ultrasound.Methods From July 2017 to July 2018,141 patients with peripheral pulmonary and pleural masses diagnosed by CT were selected as the study objects.The clinical data of the patients were analyzed retrospectively.According to different guiding methods,they were divided into two groups:contrast-enhanced ultrasound group(n=83)and conventional ultrasound group(n=58).In the conventional ultrasound group,only conventional ultrasound was performed before the percutaneous biopsy of peripheral lung and pleura masses.In the contrast-enhanced ultrasound group,conventional ultrasound and contrast-enhanced ultrasound were performed.The results of conventional ultrasound and contrast-enhanced ultrasound were recorded in detail.According to the results of pathological diagnosis,the patients were divided into malignant lesions group and benign lesions group.The diameter,blood flow signal and internal echo of the two groups were compared and analyzed.The patients in contrast-enhanced ultrasound group were divided into malignant group and benign group according to the pathological diagnosis results.The contrast-enhanced types and quantitative parameters of contrast-enhanced ultrasound were compared and analyzed,and the meaningful quantitative parameters of contrast-enhanced ultrasound were included in the ROC curve model for ROC curve analysis.The success rate and complication rate of one-time puncture were compared between contrast-enhanced ultrasound group and conventional ultrasound group.Results 1.Of the 141 patients,5 failed to take samples,136 cases of successful extraction;The results of puncture biopsy showed that,97 cases were malignant and 39 cases were benign.Of the 83 patients in the contrast-enhanced ultrasound group,1 failed to take samples8,82 cases of successful extraction;59 cases were malignant and 23 cases were benign.Among the 58 patients in the conventional ultrasound group,4 cases of failed to take samples,54 cases of successful extraction.38 cases were malignant and 16 cases were benign.The diameter of malignant lesions was(6.38±2.07)cm,which was significantly higher than that(4.19±1.02)cm of benign lesions,the difference was statistically significant(P<0.05).2.In 97 patients with malignant diseases,the distribution of blood flow signals was:grade 0 13 cases,grade ? 25 cases,grade ? 52 cases,grade ? 7 cases.In 39 cases of benign lesions,the distribution of blood flow signal was:19 cases of grade 0,14 cases of grade ?,5 cases of grade ?,1 case of grade ?.The grading of blood flow signal in malignant lesions was significantly higher than that in benign ones,the difference was statistically significant(P<0.05).3.Among 97 cases of malignant lesions,65 cases were heterogeneous hypoechoic,32 cases were homogeneous hypoechoic;Among the 39 benign lesions,20 were heterogeneous hypoechoic and 19 were homogeneous hypoechoic.There was no significant difference in internal echo between malignant and benign lesions(P>0.05).4.Among the 83 patients in contrast-enhanced ultrasound group,there were 1 failure,59 malignant lesions,23 benign lesions,54 uneven enhancement,5 Uniform enhancement,23 benign lesions,13 uneven enhancement,10 uniform enhancement;The uneven enhancement ratio of malignant lesions was significantly higher than that of benign lesions,the difference was statistically significant(P<0.05).5.Patients with malignant lesions had significantly higher lesion lung time(TAT)and arrival time(Tat)than those with benign lesions,the Mean transit time(MTT)was significantly lower than that of benign lesions,the difference were statistically significant(P<0.05).There was no significant difference in the start time(L-at),time to peak(TTP)and peak intensity(PI)between malignant and benign lesions(P>0.05).6.Include Tat,AT and MTT into ROC curve analysis,ROC curve analysis results showed that,The maximum area under the curve of Tat was 0.918,the sensitivity and specificity of Tat?2.060s were 88.73%and 92.56%respectively.7.In contrast-enhanced ultrasound group,the diameter of lesions was less than 3 cm in 21 cases,and in conventional ultrasound group,the diameter of lesions was less than 3 cm in 20 cases.There was no significant difference between the two groups(P>0.05);The incidence of complications in contrast-enhanced ultrasound group was significantly lower than that in conventional ultrasound group,the difference was statistically significant(P<0.05).8.n contrast-enhanced ultrasound group,63 cases had a diameter of?3 cm,while in conventional ultrasound group,37 cases had a diameter of?3cm;In contrast-enhanced ultrasound group,the success rate of one-time sampling and the incidence of complications were significantly lower than those in conventional ultrasound group,the difference were statistically significant(P<0.05).Conclusion 1.The diameter of malignant lesions was larger than that of benign lesions?2.Compared with conventional ultrasound-guided percutaneous lung and pleural mass biopsy,contrast-enhanced ultrasound can reduce the incidence of complications,especially for the lesions with diameter?3 cm,which can significantly improve the success rate of one-time sampling.3.Contrast-enhanced ultrasonography can better judge the benign and malignant lesions of peripheral pulmonary and pleural masses,in particular,the quantitative parameters of contrast-enhanced ultrasound Tat and AT,It provided an important clinical basis for the differential diagnosis of peripheral pulmonary and pleural masses.4.Ultrasound color blood flow signal can be used to evaluate the benign and malignant lesions of peripheral pulmonary and pleural masses.