| Objective(s): In order to provide more reasonable guidance for clinical use of CT-guided percutaneous transthoracic lung biopsy(CT-PTLB),the diagnostic value of malignant tumors and infectious diseases in solid lesions with different imaging morphology and the factors influencing the successful pathologic diagnosis were studied.Besides,in order to avoid risk factors as far as possible in clinical practice,the incidence of complications was counted and the risk factors of them were explored.Methods: The patients with solid lesions on chest CT who underwent CT-PTLB in the Second Affiliated Hospital of Kunming Medical University from June 2019 to June 2022 were retrospectively analyzed.According to the imaging manifestations,they were divided into the nodule group,mass group and consolidation group.And 263 subjects were enrolled in this study,including 94 cases in the nodule group,93 cases in the mass group,and 76 cases in the consolidation group.We collected the basic information,CT number,combined radiologic manifestations,lungs lobe involvement,punctured lungs lobe,punctured times,specifications of puncture needle,pathological results,clinical diagnosis after follow-up and complications.Then we compared the clinical characteristics of patients in different groups,and classify the pathological results(malignant or suspicious for malignancy,specific benign,non-specific benign,and non-diagnostic)to explore the diagnostic value of CT-PTLB in malignant tumors and infectious diseases in each group,as well as the factors affecting the successful pathological diagnosis.At the same time,the incidence of complications and the risk factors were analyzed.Results:1.Among 263 subjects,1 patient with puncture failed in the nodule group.The success rate of puncture in the nodule group was 98.94%,and the overall success rate of puncture was 99.62%2.We followed up 262 patients with successful puncture,and 2 patients were lost to follow-up.Among 260 patients who completed the follow-up,22 patients were misdiagnosed,with the overall diagnostic accuracy of 91.54%.3.The biopsy pathological results and clinical diagnosis results after follow-up were classified.After follow-up,the proportion of malignant tumors in the nodule group,mass group and consolidation group was 62.0%,84.9% and 40.0%,the proportion of specific benign was 29.3%,8.6% and 42.7%,and the proportion of non-specific benign was 8.7%,6.5% and 17.3%,respectively.4.The sensitivity of CT-PTLB for the diagnosis of malignant tumor in the nodule group,mass group,consolidation group and overall was 96.49%,96.20%,93.33%,95.78%,with specificity of 100.00%,and accuracy was 97.83%,96.77%,97.33%,97.31%,respectively.The sensitivity of CT-PTLB for the diagnosis of infectious diseases in the nodule group,mass group,consolidation group and overall was87.50%,83.33%,86.96%,86.67%,with specificity of 100.00%,and accuracy was97.83%,98.92%,96.00%,97.69%,respectively.5.Univariate logistic regression analysis showed that the imaging morphology of mass and consolidation,combined lobulation or spiculation,malignancy was the influencing factors for successful pathological diagnosis(P<0.05).Multivariate logistic regression analysis showed that malignancy was an independent influencing factor for successful pathological diagnosis(OR= 11.942,95%CI 4.642-30.720,P<0.05).6.In 263 subjects,the complications included pneumothorax,chest wall emphysema and hemorrhage(including pulmonary hemorrhage,hemoptysis and hemothorax),with the incidence of 40.30%,4.56% and 27.75%,respectively.7.Univariate logistic regression analysis showed that age,the needle passed ≥3times and puncture needle specification MQK1816 was the risk factors of pneumothorax(P<0.05).Multivariate logistic regression analysis showed that the needle passed ≥3 times was an independent risk factor for pneumothorax(OR=2.722,95%CI 1.593-4.650,P<0.05).8.Univariate logistic regression analysis showed that the risk factors of hemorrhage were the imaging morphology was nodule,combined ground-glass opacity,the needle passed ≥3 times,puncture needle specification of 1816MS(P<0.05).Multivariate logistic regression analysis showed that the imaging morphology was nodule(OR=2.907,95%CI 1.320-6.403,P<0.05),combined ground glass opacity(OR=1.931,95%CI 1.002-3.720,P<0.05),the needle passed ≥3 times(OR=1.836,95%CI 1.003-3.362,P<0.05),puncture needle specification of 1816MS(OR=14.547,95%CI 1.533-138.074,P<0.05)were independent risk factors for hemorrhage(P<0.05).Conclusion(s):1.CT-PTLB has a high puncture success rate and diagnostic accuracy in solid lung lesions..2.The composition of pathological results varied by the imaging group,with the highest proportion of malignant tumors in the mass group and the highest proportion of specific benign in the consolidation group.3.Malignant diseases are more likely to obtain correct pathological results in CT-PTLB.4.The needle passed ≥3 times was an independent risk factor for pneumothorax.5.Imaging morphology of the nodule,combined ground glass opacity,the needle passed ≥3 times,non-coaxial biopsy needle puncture was independent risk factors for hemorrhage. |
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