CT引导下经皮胸部穿刺活检假阴性影响因素分析

发布时间：2018-07-17 15:23

【摘要】：目的探讨CT引导下经皮胸部穿刺活检(CT-guided transthoracic core needle biopsy, TTNB)在胸部良恶性病变诊断中假阴性结果的影响因素。材料和方法回顾性分析邵逸夫医院2008年1月1日至2013年12月31日期间1339例最终诊断明确病例,收集其中的65例假阴性(不包括2例数据丢失病例)和随机抽取的106例真阳性TTNB病例的影像学、临床及病理资料。采用SPSS 20软件包进行统计学分析。分析内容包括：采用Mann-Whitney U检验对两组间的年龄、病灶大小、病灶深度、针道长度及穿刺角度进行比较分析；采用卡方检验中的Fisher精确检验对两组间的性别、病灶类型、病灶部位、有无空洞、有无坏死、穿刺体位、是否同轴穿刺、活检针类型、穿刺次数及术中有无气胸进行分析比较；两组间病灶大小、病灶深度、针道长度及穿刺角度分组间的分析比较,亦采用卡方检验中的Fisher精确检验。然后采用逻辑回归分析的方法,对于在单变量分析中有显著差异的变量进行多变量回归分析来确定假阴性结果的独立影响因素。取p0.05为有统计学差异。结果1339例中真阳性1237例,真阴性31例,假阳性4例,假阴性67例(包括2例数据丢失病例)。TTNB整体诊断准确性为94.7%(1268/1339),敏感性为94.9%(1237/1304),特异性为88.6%(31/35)；阳性预测值和阴性预测值分别为99.7%(1237/1241)和31.6%(31/98)。假阴性组和真阳性组在病灶部位(p=0.005)、病灶大小(p=0.035)、有无坏死(p=0.026)、是否同轴穿刺(p=0.017)、穿刺次数(p=0.014)、术中有无气胸(p=0.020)方面存在统计学差异,而两组间年龄(p=0.071)、性别(p=0.631)、病灶类型(p=0.812)、病灶深度(p=0.584)、穿刺体位(p=0.717)、针道长度(p=0.370)、穿刺角度(p=0.156)、活检针类型(p=0.382)无统计学差异。在多变量回归分析中,CT引导下经皮胸部穿刺活检假阴性的独立影响因素有病灶大小(OR,2.773;95%CI,1.395-5.509;P=0.004)、病灶部位(OR, 0.770;95%CI,0.651-0.911;p=0.002)、是否同轴穿刺(OR,0.245;95%CI,0.101-0.595;p=0.002)。结论病灶部位、病灶大小、有无坏死、是否同轴、穿刺次数、术中有无气胸是TTNB假阴性结果的重要影响因素；病灶部位、病灶大小、是否同轴穿刺是假阴性结果独立危险因素。
[Abstract]:Objective to investigate the factors influencing the false negative results of CT guided percutaneous transthoracic core needle biopsy, TTNB in the diagnosis of benign and malignant thoracic lesions. Materials and methods A retrospective analysis of 1339 final diagnosed cases from January 1, 2008 to December 31, 2013 in Shaw Hospital was conducted. The imaging, clinical and pathological data of 65 cases of false negative (excluding 2 cases of data loss) and 106 cases of true positive TTNB were collected. SPSS 20 software package was used for statistical analysis. Mann-Whitney U test was used to compare the age, lesion size, lesion depth, needle length and puncture angle between the two groups. The location, cavity, necrosis, position, coaxial puncture, type of biopsy needle, times of puncture and pneumothorax during operation were analyzed and compared between the two groups. Fisher precision test was also used to analyze and compare the needle length and puncture angle groups. Then, by using the method of logical regression analysis, multivariate regression analysis is carried out to determine the independent influencing factors of false negative results for those variables with significant differences in univariate analysis. P0.05 was taken as the statistical difference. Results of the 1339 cases, 1237 were true positive, 31 were true negative, 4 were false positive, 67 were false negative (including 2 data loss cases). The overall diagnostic accuracy of TTNB was 94.7% (1268 / 1339), sensitivity was 94.9% (1237 / 1304), specificity was 88.6% (31 / 35), positive predictive value and negative predictive value were 99.7% (1237r / 1241) and 31.6% (31 / 98), respectively. There were significant differences between the false negative group and the true positive group in lesion location (p0. 005), lesion size (p0. 035), necrosis (p0. 026), coaxial puncture (p0. 017), puncture times (p0. 014), and pneumothorax (p0. 020). There was no significant difference between the two groups in age, sex (p0. 631), lesion type (p0. 812), lesion depth (p0. 584), puncture position (p0. 717), needle length (p0. 370), puncture angle (p0. 156) and biopsy needle type (p0. 382). In multivariate regression analysis, the independent factors influencing the false negative of percutaneous thoracic biopsy under the guidance of multivariate regression were the size of the lesion (OR 2.773 ~ 95 CI 1.395-5.509), the location of the lesion (OR0.651-0.911p0.002), and the coaxial puncture (OR0.245C95CII 0.101-0.595p0. 002). Conclusion the location, size, necrosis, coaxis, times of puncture and pneumothorax during operation are important influencing factors for false negative results of TTNB, and the location, size and coaxial puncture are independent risk factors for false negative results.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R445.1;R56

【共引文献】