CT引导胸穿肺活检对纤支镜阴性的肺部肿块诊断价值

目的：评价CT引导下经胸穿肺活检对纤维支气管镜检查阴性的肺部肿块患的诊断价值。方法：搜集290例肺部肿块患接受CT引导下经胸穿肺活检，其中43例患曾接受过纤维支气管镜检查，又检查结果为阴性，回顾性分析了该43例患的病理结果、肿块大小和穿刺并发症情况。结果：发现恶性26例(腺癌11例、鳞癌8例、支气管肺泡癌3例、未分化癌和腺鳞癌各2例)；良性4例(结核2例、结节病1例、炎性假瘤1例)；仍有13例未能明确结果，该13例中有6例因诊断或治疗的原因行手术治疗，发现5例为恶性(鳞癌2例、未分化癌1例、小细胞癌1例、腺癌1例)，1例为良性病变(结核)。结论：CT引导下经胸穿肺活检对纤维支气管镜检查阴性的肺部肿块患有很高的临床价值，它的明确诊断率与部位关系不大，而与肿块的大小正相关。

The value of CT guiding transthoracic core needle biopsy in diagnosing pulmonary masses undetected by fiberoptic bronchoscopy

Objective:To assess the value of CT guiding transthoracic core needle biopsy (TNB) in patients with pulmonary masses undetected by fiberoptic bronchoscopy (FOB).Methods:290 patients with pulmonary masses underwent TNB.Of them 43 patients had previous FOB examination with negative or indeterminate findings.In the 43 cases with pathological findings,the size of tumor and complications caused by CT guiding TNB were retrospectively analyzed.Results:26 cases had malignant tumors including adenocarcinoma(n=11),squamous cell carcinoma(n=8),alveolar cell carcinoma(n=3),undifferentiated carcinoma(n=2) and adenosquamous carcinoma(n=2).4 had benign lesions such as tuberculosis (n=2),sarcoidosis(n=1) and inflammatory pseudotumor(n=1).A diagnosis,however,was not made by the TNB in the remaining 13 patients,of which 6 underwent thoracotomy.From these 6 cases 5 were found malignancy including squamous carcinoma(n=2),undifferentiated carcinoma(n=1),small cell undifferentiated carcinoma(n=1) and adenocarcinoma(n=1),and 1 was benign(tuberculosis).Conclusion:CT guiding TNB offers a high yield for diagnosis in those patients with pulmonary mass undetected by FOB.Results were not influenced by location, but correlated well with size of the target lesions in the lung.