MR-guided Percutaneous Puncture Biopsy Of Pulmonary Lesions:Feasibility And Risks Of Complications

Introduction:Lung cancer,originated from the bronchial mucosa or gland,is one type of malignant tumors of the highest morbidity and mortality worldwide,with approximately 2.5million new cases diagnosed and 1.5million deaths per year.In China,as the most common cancers,the morbidity and mortality rate of lung cancerwas significantly increasing year by year.According to the statistics reported by the Ministry of Health in 2008,death caused by lung cancer was the leading cause of malignacies death,which accounting for 22.7%in the cases of malignant tumor death.In addition,under the influence of increasingly severe environmental conditions,such as the air pollution,the unhealthy lifestyles,the morbidity and mortality of the lung cancer will be further increased and seriously threaten people’s health and life.Therefore,the early detection,diagnosis and treatment of lung cancer catch more and more attention today.With the development of medical imaging technology,especially the widely used of thin chest CT,more and more pulmonary nodules are detected,thus the diagnosis of lung lesions is more and more important.At present,the acquisition of pulmonary lesions tissue mainly relies on methods such as fiberoptic bronchoscope,EBUS,ultrasound,CT and MR guided percutaneous puncture and thoracoscopic pleural biopsy and others.However there were few reports about MR-guided percutaneous puncture.This retrospective study is aimed to evaluate the validity of this technology and the morbility and the causes of its complications,and then to explore the diagnostic value of MR-guided percutaneous biopsies in the diagnosis of pulmonary lesions by analyzing the cases of patients who underwent this procedure,which were gathered from the Shandong Provincial Hospital.Objective:This study was aimed to analyse the success rate,diagnostic accuracy,morbility and possible causes of complications,and evaluate the diagnostic value of the MR-guided percutaneous biopsy for the lesions of pulmonary.Methods:Based on strict inclusive and exclusive criteria,221 cases about MR-guided percutaneous biopsy were analysed retrospectively from September 2015 to August 2016 at Shandong Province Hospital.The 221 patients were divided into different groups according to age,sexual,depth of puncture and the size and properties of lesions,the distance to the pleura and the complication of emphysema.Upon the use of SPSS software,we performed univariate analysis with Chi-square(χ2)to investigate the effects of the above factors on the incidence of complications of MR-guided percutaneous puncture biopsy,such as pneumorrhagia and pneumothorax.Results:1.All the 221 cases were sampled successfully,and the success rate of puncture was 100%.2.According to the pathology diagnosis of the biopsy samples drawn in surgery,there were 155 malignancy and 65 benign lesion besides of one case of necrosis tissue.After the thoracic surgery,according to the postoperation pathology,effectiveness of the clinical treatment and the follow-up visits,it is confirmed that there were 165 cases of malignancy and 56 cases of benign.3.In accordance with the above statistics,the rate of accuracy,sensitivity,specificity and the positive and negative predictive value of the MR-guided percutaneous biopsy was 94.6%,93.9%,100%,100%and 89.6%respectively.4.In addition,52 patients developed pneumorrhagia(23.5%),the relative risk factors of which were properties,size and the position relationship with pleura(p<0.05)of the lesions;22 patients had pneumothorax(10.0%),the relative risk factors of which were the depth of the puncture and the existence of preoperative emphysema(p<0.05).Conclusion:1.The MR-guided percutaneous puncture biopsy is a noninvasive diagnosis method without radiation damage that has significant clinical value of pulmonary lesions.2.The success rate of the MR-guided percutaneous puncture biopsy is 100%in this research,and the precision rate of diagnosis of pulmonary lesions is 94.6%.Meanwhile,the rate of sensitivity and specificity is 93.9%.100%respectively.All the rate of accuracy,sensitivity,specificity,and the positive and negative predictive value are indicated at a high level.3.The MR-guided percutaneous puncture biopsy is few-complicated,less-injury and with high safety.The main complications of this method are pneumorrhagia and pneumothorax,the relative risk factors of which are properties,size and the position relationship with pleura of the lesions the former,and meanwhile the depth of the puncture and the existence of preoperative emphysema the latter.