The Value And Safety Study Of CT-guided Percutaneous Biopsy Of Lung GGN

Objective First,the CT findings,biopsy results and final diagnosis of lung ground glass nodules were statistically analyzed.The diagnostic value of CT-guidance percutaneous biopsy of lung ground-glass nodules and the clinical need of biopsy were needed to confirm the indications for the diagnosis.It is necessary to early diagnosis,and also to avoid abuse.Second,by analyzing the failure cases of CT-guided percutaneous biopsy of lung GGN and the influencing factors of common postoperative complications,the related factors,prevention and treatment methods were summarized to improve the success rate and safety of CT-guided percutaneous biopsy of lung GGN.Last,the clinical data of 24 cases with systemic air embolism after biopsy were analyzed,and the location,CT and clinical manifestations,precautionary measures and prognosis after early treatment were summarized,and the understanding,diagnosis and treatment of this complication were improved and accumulate experience for the safety guarantee of CT-guided biopsy of lung GGN.Materials and Methods Accuracy analysis of CT-guided percutaneous Biopsy of lung GGN.A total of 121 patients with ground-glass nolules in the lungs,which were diagnosed by chest CT scan from March 2015 to December 2016,were not diagnosed by conventional sputum cytology and fiberoptic bronchoscopy.40 males and 81 females,the age range is 26-78 years old,with an average age of 58.85 years.The study of the group criteria:(1)lung ground-glass nolules,including pure ground-glass nolules and mixed ground-glass nolules;(2)Thin slice 3D CT examination of lung GGN;(3)CT guided lung GGN biopsy in patients with pathological results;(4)Surgical removal of pathological sections or follow-up observation after treatment confirmed the nature of the disease;(5)complete clinical data and CT images can clearly describe the disease;(6)consent and signature of patients and their families.Exclusion criteria:(1)The lung GGN were adjacent to the heart,large vessels or the trachea,and had no safe puncture route;(2)incomplete puncture and taken specimens were normal and only normal tissue;(3)patients who can't tolerate puncture and can't be checked;(4)bleeding tendency of patients;(5)needle through the site of bullous emphysema;(6)suffering from severe pulmonary hypertension or poor heart and lung function.The patient's general information(age,gender,symptoms,smoking history)was recorded and some CT findings of lung GGN were recorded,including the location of the lesion,size,internal components and some characteristic findings(vacuolar sign,air bronchogram,lobulation sign,spiculation sign,pleural indentation,vascular bundle sign)and so on.The pathological findings of all the patients and the final diagnosis results of the patients were recorded.The accuracy of CT-guided percutaneous lung biopsy in diagnosing the lung GGN and the coincidence of pathological type were also analyzed.According to the final diagnosis,the patients were divided into two groups: benign lesions and malignant lesions.Statistical data of the two groups were analyzed statistically.CT imaging information(lesion distribution,internal features and characteristic radiological findings)judgment to provide help.Analyze the influencing factors of common complications and failure of puncture.According to the results of biopsy,the patients were divided into success group and failure group.The success group was defined as successful biopsy and pathological results.The failure group was defined as those with unsuccessful or abnormal pathological results.The factors affecting the biopsy failure were recorded,including general data(age,gender),lesion size(the longest diameter,location,non-solid ratio and presence of emphysema),puncture(depth of lung puncture,length of needle path and times of pleural puncture)and records of all patients with postoperative complications,including: hemoptysis,lung hemorrhage,pneumothorax,hemothorax,Systemic air embolism,and record the influence factors of complications related to: general data,lesions and puncture complications.Analyze rare and fatal complications with systemic air embolism in 24 cases.Data on patients with systemic air embolism in all CT-guided percutaneous lung biopsy from March 2015 to February 2018 were collected.There were 10 males and 14 females with an average age of 60.67±8.19 years.Inclusion criteria:(1)chest CT findings of the lung shadow,showed mass,nodular,patchy shadow or ground glass opacity.(2)lung shadows underwent CT-guided percutaneous biopsy.(3)postoperative CT examination revealed the presence of free gas in the cardiovascular system,or postoperative central nervous system and cardiovascular system symptoms and signs and CT reexamination can found free gas in the corresponding parts of the blood vessels.(4)cases before and after CT and other clinical data complete.All patients were recorded with gender,age,location of lesions,size(longest diameter),morphology(lumps,nodule,patchy shadows,GGN,cavities,etc.),and position during operation,pathological results and other complications(cough,hemoptysis,pulmonary hemorrhage,etc.).And the patients were recorded whether to receive whole-lung low-dose CT scan and/or craniocerebral CT scan immediately after operation,the location of gas embolism,whether there were clinical symptoms and clinical symptoms were earlier than the CT scan after the operation immediately,whether they got up or standed up,whether the gas embolism were absorbed,whether there were rescue treatments,whether there were sequelaes,whether they died,etc.Results Among the 121 patients,the accuracy of CT guided percutaneous GGN biopsy was analyzed in the remaining 112 patients,including 37 cases of pure ground glass nodules and75 cases of mixed ground glass nodules,except 5 cases of puncture failure,2 cases of no follow-up and 2 cases of microwave ablation.Biopsy results included 79 cases of adenocarcinoma,1 case of metastatic adenocarcinoma,1 case of mucinous adenocarcinoma,1 case of undifferentiated carcinoma,8 cases of atypical adenomatous hyperplasia,14 cases of chronic inflammatory disease and 6 cases of fibrosis,tuberculosis in 1 case,lymphoid hyperplasia in 1 case.In 112 patients,85 cases(75.89%)were diagnosed malignant lesions by surgery or therapeutic review,and 27 cases were benign lesions.The sensitivity,specificity and accuracy of CT-guided percutaneous lung biopsy were 96.47%(82/85),100%(27/27),and 97.32%(109/112)respectively for the differential diagnosis of lung ground-glass nolules.Of the 82 malignant lesions,72 were confirmed by surgery.Only 2of them were out of line with the final surgical pathology.The diagnostic accuracy of pathological typing was 97.22%(70/72).The proportion of female patients in the malignant group was higher than that of the benign group,but there was no difference in age,cough and smoking history between the two groups.In the benign lesion group,the inferior lobe lesions were more common(14 cases,51.85%),while in the malignant lesion group,the upper lobe lesions were more common(48 cases,56.47%).There was a significant difference in the distribution of lesions between the two groups(P<0.05).In terms of lesion size,there was no significant difference between the two groups(P>0.05).In the internal structure of the lesion,the proportion of non-solid components in the malignant lesion group was lower than that in the benign lesion group(P<0.05),that was to say,the lesion with more solid component was more likely to be malignant.We got the ROC curve analysis of non-solid components of benign and malignant lesions and the area under the curve AUC was 0.696,95% confidence interval 0.591-0.801(P=0.002),the critical value of 0.427.When the proportion of non-solid ingredients<0.427 to determine the malignant lesions,the sensitivity was 0.815 and the specificity was 0.612.In terms of CT imaging signs,there were significant differences between the two groups in the signs of vacuolar sign,lobulation sign and vascular bundle sign(P<0.05),but there was no significant difference in air bronchogram,burr sign and pleural indentation between the two groups statistical significance(P>0.05).121 cases of lung GGN underwent CT-guided percutaneous lung biopsy,5 patients failed to puncture,1 case of moderate pneumothorax,1 case of hemorrhage,2 cases were only normal lung tissue samples obtained by puncture,1 case of a small amount bone tissue and normal lung tissue.The results showed that small GGN and inferior lobe GGN were easy to fail in puncture,but due to too few cases in the failure group,the differences between the two groups were not statistically significant(P value was 0.068 and 0.064,respectively).121 cases of biopsy patients,less and moderate pneumothorax occurred in 26 cases,of which a small amount of pneumothorax in 25 cases;78 cases of medium pulmonary hemorrhage,and a small amount of needle tract bleeding in 43 cases;a small amount of pleural effusion in 6 cases;a small amount of hemoptysis in 3 cases;systemic air embolism in 2 cases.Univariate logistic regression analysis showed that the influencing factors of complicated pneumothorax included lesion location(P<0.001),times of pleura puncture(P<0.001)and emphysema along the needle path(P=0.002);Multivariate logistic regression analysis showed that the lesion located in the inferior lobe(OR=4.398,95%CI1.720~11.242,P=0.002)?two and more than two times of pleural puncture(OR=3.563,95%CI 1.1.357~9.358,P=0.010)and emphysema along the needle path(OR=10.676,95%CI 1.073~106.250,P=0.043)were independent risk factors for pneumothorax.Univariate Logistic regression analysis showed that the influencing factors of moderate pulmonary hemorrhage included the longest diameter of GGN lesion(P<0.001),length of needle path(P=0.032),and depth of lung puncture(P=0.001).Multivariate Logistic regression analysis suggested that the longest diameter of GGN lesion(OR=0.923,95%ci 0.883~0.965,P<0.001)and depth of lung puncture(OR=1.115,95%ci 1.039~1.198,P=0.003)were independent risk factors for the occurrence of moderate pulmonary hemorrhage.All 24 patients with systemic air embolism underwent immediate low-dose CT reexamination of the whole lung.All patients found embolic gas in the left atrium and/or left ventricle,including 16 cases found gas only in the left ventricle and 2 cases found embolic gas only in the left atrium,At the same time,gas was also found in 3 cases of cephalic trunk,aortic arch and descending aorta,and gas was found in each one case of right coronary artery,pulmonary artery and cerebral artery.23 patients were found with no clinical symptoms,and were placed in the original position without standing or getting up and given continuous high flow of pure oxygen.After 30-60 minutes of reexamination,all the embolic gases were absorbed,and the patients went out the examination room without any adverse reactions and sequelae.One patient with right coronary air embolization showed symptoms of acute coronary syndrome,such as restlessness and decreased blood pressure,1 minute after gas embolism was found.Also kept the patient in the original position without standing or getting up,given positive symptomatic treatment,and the patient was discharged safely without any adverse symptoms.The embolization site of gas emboli was related to the different positions during puncture.The statistical results of fisher's exact probability method showed that the differences of each group were statistically significant(P=0.025).The incidence of exocardial air embolism in right lateral position and supine position was lower than that in left lateral position and prone position,but due to the small sample size,the pairwise comparison between different positions was not statistically significant.Supine position compare with right lateral position with P=0.632,Right lateral position compared with left lateral position with P=0.125,left lateral position comparison with prone position with P=0.600,Supine position compare with prone position with P=0.136,Supine position compare with left lateral position with P=0.154,Right lateral position compared with prone position with P=0.109.Conclusion1.CT guided percutaneous coaxial biopsy of lung GGN is an accurate,safe and feasible method.2.Immediate low-dose whole-lung CT scanning after biopsy can detect asymptomatic systemic air embolism at an early stage,keep the original position motionless,and wait for gas absorption,helps to avoid the occurrence of serious events.