Clinical Application Of Computed Tomography-Guided Transthoracic Lung Biopsy

objective To investigate the efficacy and safety of computed tomography-guided transthoracic lung biopsy(CT guided TTLB),and to explore the strategies for more diagnostic yield and lower complication.METHODS:Totally 400 cases who underwent CT-guided TTLB were enrolled.The CT images were analyzed carefully and the optimal approach was selected.The lung biopsy was performed with Argon coaxial trocar and biopsy needle.In some cases,the combination of CT and PET CT guided TTLB was applied.RESULT:The rate of success puncture was 100%,of which 380 cases succeed at the first time,45 cases'diameter of the lesion was less than 2 cm,the smallest lesion was solid nodules 0.5cm in diameter;360 case(90%).have peripheral lesions diagnostics rate was 95%,312(78%)were lung cancer,30 cases(7.5%)were acute and chronic inflammation,28 cases(7%)were tuberculosis,21 cases(5.25%)were organic pneumonia,8 cases(2%)were vasculitis and granulomatous lesions,5 cases(1.25%)were fungal pneumonia,3 cases(0.75%)were lymphoma,1 case(0.25)was esonophilic pneumonia.67 cases(16.75%)had complication during or after operation,including 35 cases(8.75%)of pneumothorax,33 cases(94.29%)absorbed by themselves within 24 hours without drainage,2 case(5.71%)were given closed drainage and extubated after 24 hours;30 cases(7.5%)had pulmonary hemorrhage,including 29 cases(7.25%)of hemoptysis and coughing fits with blood-tinged sputum,stopped bleeding after intravenous infusion of zibatotitne.2 cases have pleural hemorrhage,account for 0.5%,relieved after Intravenous hemostatic drug,without the occur of fatal complications25 cases with peripheral lesions who had EBUS--GS-TBLB were analyzed.Among the 25 cases,16(64%)cases have lesion large than 3cm in diameter,6(24%)had lesion of 1-3 cm in diameter,and 3(12%)had lesion smaller than 1cm in diameter.Pathological results:21 cases obtained the success specimen,account for 84%,19 cases were definitive diagnosis,in which 18 cases(%)were lung cancer,1 case(%)was tuberculosis and 1 case(%)was inflammatory pseudo tumor.The diagnostic rate was 76%.The diagnostic rate of TTLB was higher than EBUS-GS-TBLB p(0.05).Conclusion:CT guided TTLB is an accurate,effective and safe measure.The key points of procedure include analyzing CT images carefully to select the optimal approach away from blood vessel.Although EBUS-GS has very little rate of complication but our main aim is to give the patient with perfect diagnosis.Especially small nodules are difficult to diagnose by the Trans bronchial biopsy TBB.For complex cases multiple biopsies guided by PET CT or combined with CT guide TTLB and clinical data can increase the diagnostic accuracy.