The Comparison Between Two Methods Of CT-guided Percutaneous Transthoracic Biopsy

Objective: To compare the satisfaction rate of specimen, the positive rate of pathological, the detection rate of malignant lesion, the detection rate of the pathogen and the incidence of complications between the enhanced CT-guided group and the conventional CT group. To investigate the clinic value of enhanced CT-guided percutaneous transthoracic biopsy and the application value of fine needle aspiration biopsy in the enhanced CT group.Methods: A retrospective analysis was conducted. Totally 423 patients met the inclusion criteria who underwent CT-guided percutaneous transthoracic biopsy in Tianjin Chest Hospital were retrospectively analyzed during the July 2005 to July 2014. Compare the satisfaction rate of specimens, the pathological positive rate, the detection rate of malignant lesion, the detection rate of the pathogen, the average number of biopsy, the rate of replace the puncture point and the complications between the enhanced CT group and the conventional CT group. A few cases which the patients cannot using the spring needle biopsy, using fine needle aspiration biopsy were analyzed by statistical method.Results:1. A total of 423 patients were included in the study(257 males and 166 females), the age range was 22~ 85 years old, the average was 61.71 years old, 178 of them were taken conventional CT for positioning and 245 of them were taken enhanced CT for positioning. Among of them,259 patients which lesions located under the pleural membrane, 164 patients which lesions located away from the pleural membrane(the puncture needle through the normal lung tissue), 23 small lesions(maximum diameter <2cm), 85 patients complicated with chronic obstruction pulmonary disease(COPD), 15 patients complicated with pulmonary fibrosis. There is no significant difference in the distribution of gender, age, the percentage of small lesions, the percentage of lesions located away from the pleural membrane, the percentage of patients complicated with chronic obstruction pulmonary disease(COPD) and the percentage of patients complicated with pulmonary fibrosis(P>0.05). 2. The satisfaction rate of specimen for the enhanced CT group and the conventional CT group was 90.13% and 73.60% respectively. There was statistical significancebetween two groups(P<0.01). 3. The positive rate of pathological for the enhanced CT group and the conventional CT group was 76.62% and 63.36% respectively. There was statistical significance between two groups(P<0.01). 4 The detection rate of malignant lesion and the detection rate of the pathogen between the enhanced CT group and the conventional CT group was statistically significant(94.51%vs85.00%, 56.14%vs34.69%, P<0.05). 5. Compare with the enhanced CT group and the conventional CT group, the average number of biopsy and the rate of replace the puncture point in patients was statistically significant(3.08±1.05vs3.75±1.34, 8.52%vs18.54% P<0.01). 6. The incidence rate of pneumothorax and hemorrhage between the enhanced CT group and the conventional CT group was statistically significant(15.51%vs27.53%,7.76%vs14.04%,P<0.05). 7 There were 22 cases using fine needle aspiration biopsy without using spring needle biopsy in the enhanced CT group.13 of them were positive, they were all lung cancer. The positive rate was 59.09%.Conclusion: The satisfaction rate of specimen and the detection rate of diseases are higher, the complication is fewer under the enhanced CT-guided percutaneous transthoracic biopsy. It is easier to obtain the positive pathological result in using enhanced CT. It is benefit for rational and efficient select inspection methods, and reduces the number of biopsies. So the enhanced CT-guided percutaneous transthoracic biopsy is more safe and worth to be promoted. In a few cases, which the patients cannot using the spring needle biopsy, using fine needle aspiration biopsy has some application value too. But this method not suitable for the patients of hypersensitivity to iodinated contrast media, patients with hyperthyroidism, patients with renal insufficiency and the diabetics using metformin recently.