CT引导下经皮穿刺活检在纵隔占位性病变中的诊断价值

发布时间：2018-02-10 11:39

本文关键词： 纵隔病变活组织检查 CT引导诊断价值　出处：《医学研究生学报》2017年11期 　论文类型：期刊论文

【摘要】：目的国内对于CT引导下经皮穿刺活检在纵隔占位性病变中应用的研究较少。文中主要探讨CT引导下穿刺活检术在诊断纵隔占位性病变的临床应用价值及其安全性。方法回顾性分析2009年1月至2017年6月就诊于南京军区南京总医院呼吸与危重症医学科行CT引导下经皮穿刺活检术的81例纵隔占位性病变患者资料。活检标本行细胞学及组织学检查,对形态学恶性标本进一步行免疫组化染色,以最终诊断为金标准,统计CT引导下经皮穿刺活检术在纵隔占位性病变诊断中的准确性、特异性、敏感性、阳性预测值及阴性预测值和并发症情况。结果 81例患者均顺利完成CT引导下穿刺活检,77例获得明确诊断,确诊率为95.1%。恶性病变68例(84.0%),包括非小细胞肺癌44例,小细胞肺癌6例,淋巴瘤11例,恶性胸腺瘤4例,基底细胞癌1例,后纵隔恶性肿瘤1例,上皮样血管内皮瘤1例;良性病变10例(12.3%),纤维组织增生/大片坏死物2(2.5%)。CT引导下经皮穿刺活检的敏感度、特异度、准确性、阳性预测值及阴性预测值分别为94.4%、100%、95.1%、100%、69.2%。所有患者均能耐受操作,术中及术后除观察到少量气胸、咯血、穿刺点少量出血外,未出现纵隔气肿、纵隔血肿、大血管损伤破裂出血、纵隔炎等罕见并发症。结论对于纵隔占位性病变的患者,CT引导下经皮穿刺活检是一种高效、安全的检查手段,具有较高的敏感度、特异度和确诊率,可为后续治疗提供帮助。
[Abstract]:Objective to investigate the clinical value and safety of CT guided percutaneous biopsy in the diagnosis of mediastinal space occupying lesions. Methods from January 2009 to June 2017, 81 patients with mediastinal space occupying lesions treated by CT guided percutaneous biopsy in Department of Respiratory and critical Care, Nanjing General Hospital of Nanjing military region were retrospectively analyzed. Biopsy specimens were performed. Cytological and histological examination, The accuracy, specificity and sensitivity of CT guided percutaneous biopsy in the diagnosis of mediastinal space-occupying lesions were analyzed. Results the positive predictive value, negative predictive value and complications were all successfully completed in 77 patients with CT-guided biopsy. The diagnosis rate was 95.1.The malignant lesions were diagnosed in 68 cases, including 44 cases of non-small cell lung cancer (NSCLC). There were 6 cases of small cell lung cancer, 11 cases of lymphoma, 4 cases of malignant thymoma, 1 case of basal cell carcinoma, 1 case of posterior mediastinal malignant tumor and 1 case of epithelioid hemangioendothelioma. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CT-guided percutaneous biopsy were 94.40.100 and 95.1cm, respectively. All patients were able to tolerate the operation. Except for a small amount of pneumothorax, hemoptysis and a little bleeding at puncture point, there was no mediastinal emphysema, mediastinal hematoma, rupture of major vascular injury and hemorrhage during and after operation. Conclusion CT guided percutaneous biopsy is an effective and safe method for mediastinal mass disease patients with high sensitivity, specificity and diagnostic rate, and can be helpful for subsequent treatment.
【作者单位】：南京大学医学院附属金陵医院(南京军区南京总医院)呼吸与危重症医学科;
【基金】：国家自然科学基金(81572273,81772500,81602015) 江苏省自然科学基金(BK20161386)
【分类号】：R564;R816.4

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