| Objective:To explore the diagnostic value of CT-guided percutaneous lung biopsy for pulmonary nodules,and analyze the risk factors leading to undiagnosed puncture and complications.Methods:This study is a retrospective study of patients with pulmonary nodules who underwent CT-guided percutaneous lung biopsy at the First Affiliated Hospital of Nanchang University from June 1,2020 to August 31,2022.The patient’s case data,pathological results after puncture,pathological results after surgical resection of nodules and nodules after treatment were collected.The diagnosis rate of puncture was calculated and the difference in the diagnosis rate of nodules in different groups was analyzed,and the risk factors leading to undiagnosed puncture and complications were analyzed.Results:1.Among the 291 cases finally included,246 were confirmed by puncture and45 were undiagnosed,with a confirmed puncture rate of 84.54%.2.The diagnosis rate of malignant nodules by puncture was 86.26%,and that of benign nodules was 68.97%.The difference between the two groups was statistically significant(p < 0.05).3.The diagnostic rates of lung solid nodules,mixed nodules and ground glass nodules by puncture were: 90.14%,87.57% and 66.67%,the difference between the three groups was statistically significant(p < 0.05),and pairwise comparison showed that there were statistically significant differences in the puncture diagnosis rates between realistic nodules and ground glass nodules and between mixed nodules and ground glass nodules(p < 0.05).The diagnosis rate of puncture with diameter ≤10mm was 64.29%,and that of puncture with diameter 10-30 mm was 87.95%,the difference between the two groups was statistically significant(p < 0.05).The puncture diagnosis rate of pulmonary nodules was 85.24%,and that of subpleural nodules was75%.No significant difference was found between the two groups(p > 0.05).4.Univariate analysis showed that nodule density,nodule size,pulmonary distribution,puncture distance and benign and malignant nodules were related to undiagnosed puncture(p < 0.05).Multivariate analysis showed that ground glass nodule,nodule diameter ≤10mm,nodule distribution in the lower lobe,puncture distance ≥6cm and benign nodule were independent risk factors for undiagnosed puncture(p < 0.05).5.The incidence of pneumothorax after puncture was 16.83%.The incidence of pneumothorax after puncture was 14.08%,19.53% and 13.3% for solid nodules,mixed nodules and ground glass nodules,respectively,and there was no statistical significance in the incidence of pneumothorax among the three groups(p > 0.05).The incidence of pneumothorax after puncture was 28.57% for nodules with a diameter of less than 10 mm,and 14.86% for nodules with a diameter of 10-30 mm,and the difference between the two groups was statistically significant(p < 0.05).The incidence of post-puncture pneumothorax was 17.34% for nodules located in the lung and 10.0% for subpleural nodules.No significant difference was found between the two groups by comparison(p > 0.05).6.Univariate analysis showed that nodule size,pulmonary distribution,emphysema,pleural distance and body position were related to the occurrence of pneumothorax after puncture(p < 0.05).Multivariate analysis showed that nodule diameter ≤10mm,distribution in the lower lobe,emphysema and pleural distance≥3cm were independent risk factors for pneumothorax after puncture(p < 0.05).7.The incidence of post-puncture bleeding was 12.03%.The incidence rates of post-puncture hemorrhage of solid pulmonary nodules,mixed nodules and ground glass nodules were: 9.86%,7.10% and 31.37%,and statistically significant differences were found among the three groups(p < 0.05).Pairwise comparison showed that there were statistically significant differences in the incidence of hemorrhage between realistic nodules and ground glass nodules,and between mixed nodules and ground glass nodules(p < 0.05).The incidence of hemorrhage after puncture was 30.95% for nodules with a diameter of less than 10 mm,and 8.83% for nodules with a diameter of 10-30 mm,and the difference between the two groups was statistically significant(p < 0.05).The incidence of post-puncture bleeding was12.18% for nodules located in the lung and 10.0% for subpleural nodules.No significant difference was found between the two groups(p > 0.05).8.Univariate analysis showed that nodule density,nodule size and puncture distance were related to bleeding after puncture(p < 0.05).Multifactor analysis showed that ground glass nodule,nodule ≤10mm and puncture distance ≥6cm were independent risk factors for bleeding after puncture(p < 0.05).Conclusions:Ct-guided percutaneous pulmonary puncture biopsy has high diagnostic value for pulmonary nodules and controllable adverse reactions,but the necessity of puncture should be repeatedly evaluated for small ground glass nodules. |
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