摘要
目的探讨CT引导下纵隔肿瘤穿刺活检术的方法、原则及不同类型活检针的应用价值。方法将连续就诊的50例纵隔肿瘤患者进行CT引导下穿刺活检,其中采用16G穿刺针活检26例患者(男14例,女12例,平均年龄39.5岁),采用18G穿刺针活检24例患者(男14例,女10例,平均年龄42.1岁)。50例均做病理组织学检查,38例加做免疫组织化学检查。以术后病理或治疗后6个月的追踪作为最后诊断,比较2种方法的差异。结果病变位于前纵隔33例,中纵隔10例,后纵隔7例;43例病理诊断明确:胸腺瘤13例,恶性淋巴瘤12例,腺癌5例,鳞癌、小细胞癌各4例,畸胎瘤、精原细胞瘤各1例,神经纤维瘤、恶性神经鞘膜瘤、小圆细胞恶性肿瘤各1例;7例病理诊断不确定:临床诊断为恶性淋巴瘤3例,纵隔淋巴结结核2例,经手术病理诊断为胸腺瘤、腺癌各1例;穿刺活检敏感性为86.0%,假阴性率为14.0%,未见假阳性病例。26例患者应用16G针活检,共取材39针,平均每例1.5针,敏感性96.2%,特异性100%,出现气胸2例,咯血1例。24例患者应用18G针活检,共取材49针,平均每例2.0针,敏感性75.0%,特异性100%,出现气胸1例,咯血1例。2组之间进针次数与敏感性比较,差异有统计学意义(P值分别为0.003、0.033)。结论掌握正确的方法进行CT引导纵隔肿瘤穿刺活检术是纵隔肿瘤安全而有效的诊断方法,选用16G活检针具有更高的敏感性。
[Objective] To investigate the method of CT guiding percutaneous transthoracie needle biopsy and evaluate of different biopsy needle for mediastinal masses. [Methods] CT-guided 16 gauge needle biopsy of mediastinal tumors was performed in 26 patients, 14 males and 12 females, aged 39.5, and CT-guided 18 gauge needle biopsy was performed in 24 patients, 14 males and 10 females, aged 42.1. Pathological examinations were done in all eases, and immunohistoehemical methods were used in 38 eases. The final diagnosis was based on the post-operative pathological examination and/or the results of 6-month follow-up. [Results] The location of lesions： in anteriormediastinum （n =33）, in middlemediastinum （n =10）, in posteriormediastinum （n =7）. Pathological diagnosis was established in 43 cases, including thymoma （n =13）, lymphoma （n =12）, adenocacinoma （n =5）, squamousearcinoma （n =4）, small cell carcinoma （n =4）, teratoma （n =1）, germ cell tumor （n =1）, neurofibroma （n =1）, malignant neurilemmorea （n =1）, small round cell tumor （n =1）. Uncertain diagnosis by pathology in 7 cases included elinieally suspected lymphoma （n =3） and tuberculosis （n =2）; 1 thymoma, I adenocacinoma was colifirmed by surgical and pathological findings respectively. The diagnostic accuracy of percutaneous biopsy was 86.0%, and the false negative rate was 14.0%. In the CT-guided 16 G needle biopsy, 39 passes were performed with an average of 1.5 pass, a sensitivity rate of 96.2%, and a specificity rate of 100%, and pneumothorax occurred in 2 cases, and bloodysputum occurred in 1 case. In the CT-guided 18 G needle biopsy, 49 passes were performed with an average of 2.0 passes, a sensitivity rate of 75.0%, and a specificity rate of 100%, and pneumothorax occurred in 1 case, and bloodysputum occurred in. 1 case. The number of pass of the 16 G was significantly less than that of the 18 G group （P=0.003）. The sensitivity rate of the 16 G needle biopsy was significantly higher than that of the 18 G group （P=0.033）. There was no statistic significance in the complications rate between the two groups （P=0.709）. [ Conclusions ] Transthoraeie needle biopsy of mediastinal masses with CT guidance is a safe and valuable diagnostic procedure by accurate process. CT-guided 16 gauges core needle biopsy is more sensitive than the 18 G biopsy for the diagnosis of mediastinal masses.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2009年第18期2810-2813,共4页
China Journal of Modern Medicine
