| Objective:To investigate the diagnostic value,the incidence of complications,and other related risk factors with CT-guided PTNB for pulmonary nodules,Methods:A retrospective analysis was used to patients diagnosed with small pulmonary nodules by CT screening,who were also endured with CT guided PTNB.The results of cytology and(or)pathology were obtained in Zhenjiang First Hospital from 2014 to 2018.Recording and counting the results of the needle-biopsy times were made and other relative factors were considered,such as the patients' gender,age,smoking history,chest surgery history,the number of bullae in lung,COPD history,nodule charactor,nodule maximum diameter,needle-biopsy position in the surface of chest,vertical-direction angle,needle-biopsy depth,patient position,the needle-biopsy times,and postoperative complications such as pneumothorax,hemoptysis,hemothorax,air embolism,needle-way metastasis and death etc.The patients with malignant nodules were followed up,and their surgical pathological results were obtained too,which were compared with needle-biopsy pathologically.The SPSS 23.0 statistical software were used to the data and a univariate analysis was used to the above factors,in which t-test was applied for continuous variables and chi-test was used for categorical variables.The P value set as less than 0.15 was significant,on the purpose of accuracy of the results.Then logistic regression analysis was performed on the significant factors and OR values were recorded as well.Results:A total of 200 needle-biopsy cases were enrolled,and the needle-biopsy samples were obtained in all cases.But the pathological or cytological results were demonstrated in 136 cases,and the pathological result rate of needle-biopsy was 68%.There were 72 cases of malignant nodules,including 16 cases of squamous cell carcinoma,40 cases of adenocarcinoma,3 cases of non-small cell lung cancer with unknown classification,7 cases of small cell carcinoma,and 1 case of neuroendocrine carcinoma.Furthermore,another 4 cases among the cases of malignant nodules could not be classified pathologically.Besides of the cases of malignant nodules,there were64 cases with benign nodules,in which 7 cases were tuberculosis infection,and 2cases were fungal infections.Among the left 64 cases 13 cases were normal lung tissue and 8 were blood clots.Patients with malignant nodules were followed up and55 patients were underwent for surgery.The needle-biopsy pathological result rate was 89%(49/55)in all operated patients.In single-factor analysis the needle-biopsy success rate depended on SN(P=0.035),GGN(P=0.005),diferent needles(P=0.000)?body position(P=0.028)and needle-biopsy times(P=0.005).In logistic analysis(P value was set less than 0.15)SN,GGN,body position and needle-biopsy times were independent factors for the needle-biopsy success.The highest success rate was found in SN patients(P=0.036,OR=0.247)?The lower success rate in GGN cases(P=0.009 OR=0.454),prone position(P=0.03,OR=0.429)and lateral position(P=0.03,OR=0.619)However,the needle-biopsy failure was related to the needle-biopsy times such as the needle-biopsy times more than two(P<0.05,OR=0.064),or the needle-biopsy times equal to or more than three(P<0.05,OR=0.016).Complications Postoperative pneumothorax occurred in 32 cases(16%),hemoptysis in 13 cases(6.5%),hemothorax in 2 cases(1%),death in 0 cases,needleway metastasis in 0 cases,and air embolism in 0 cases.Twenty-one patients with pneumothorax were improved after oxygen therapy,and 11 patients were in need of thoracentesis or chest drainage.Patients with hemorrhage were improved after bed rest and hemostatic treatment.The results showed that the history of smoking(P <0.05,OR = 4.05),the presence of COPD(P <0.05,OR = 6.481),and the needle-biopsy position in the lateral position(P<0.05,OR = 1.746)were the risk factors for pneumothorax.Hemorrhage occured only in few patients,so no risk factors for bleeding were found up to now.Conclusion:CT-GPTNB has a high diagnostic value for small pulmonary nodules,but there is still a certain incidence of needle-biopsy failure.Therefore,if a lung needle-biopsy operation is determined for patients with small pulmonary nodules other factors should also be considered such as patient's health condition,imaging and clinical physician's judgment.The pathological results of malignant nodules are consistent with the pathological results of surgery.The needle-biopsy complications are relatively few,however the complications may occur in patients with a history of smoking and COPD.In general oxygen therapy is useful for the most of pneumothorax,and hemorrhage patients can also be cured after hemostatic treatment.Up to now in the study,there are no severe complications such as death,needleway metastasis,and air embolism.In a word,CT-GPTNB can be widely applied in some patients who have small pulmonary nodules. |
PDF Full Text Request