超声引导穿刺活检在胸膜下肺部疾病诊断中的应用价值

doi:10.3760/cma.j.cn101202-20210206-00036

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摘要目的探讨超声引导穿刺活检在胸膜下肺部病灶定性诊断中的应用价值。方法回顾性病例对照研究。纳入2018年1月—2020年11月蚌埠医学院第一附属医院胸外科胸膜下肺部疾病患者178 例,其中男120例、女58例,年龄22~69(57.3±7.8)岁。患者均接受外科手术治疗,术前均行超声引导穿刺活检。以外科手术病理诊断为金标准分为良性组(56例)和恶性组(122例),比较两组患者肺部病变超声声像表现的差异。观察超声引导穿刺活检取材成功率和并发症发生率,统计超声引导穿刺活检诊断胸膜下肺部疾病的准确率、灵敏度、特异度、阳性预测值、阴性预测值及95%可信区间(CI)。结果两组患者性别、年龄等基线资料比较,差异均无统计学意义(P值均＞0.05)。两组患者肺部病变的超声声像表现在形态、是否有空气支气管征、血流信号等方面差异均有统计学意义(P值均＜0.05),而在病灶侧别、边界、内部回声等方面差异均无统计学意义(P值均＞0.05)。超声引导穿刺活检一次穿刺取材成功率96.07%(171/178),并发症发生率3.31%(6/178);诊断准确率93.82%(95% CI 89.21%~96.88%)、灵敏度90.98%(95% CI 84.44%~95.41%)、特异度100%(95% CI 92.32%~100%)、阳性预测值100%(95% CI 95.98%~100%)及阴性预测值83.58%(95% CI 72.77%~90.75%)。结论胸膜下肺部病变的超声表现可为良恶性病变的鉴别诊断提供一定信息,且超声引导穿刺活检具有实时观察、并发症发生率低、诊断准确率高等优点,对于胸膜下肺部疾病的诊断具有重要临床价值。

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	路明宇
	都晓英
	李阳
	张雷
	苏蕾
	郭婕
	侯迎迎
	朱敏
	郭飞飞
	孙医学

关键词 ：超声检查, 胸膜下肺部疾病, 活组织检查,针吸

Abstract：Objective This study aimed to explore the application value of ultrasound-guided percutaneous puncture biopsy in the diagnosis of subpleural pulmonary lesions.Methods A retrospective case-control study was conducted. The data of patients with subpleural lung disease who underwent ultrasound-guided puncture biopsy in the First Affiliated Hospital of Bengbu Medical College from January 2018 to November 2020 were included. A total of 178 patients comprising 120 males and 58 females aged 22-69(57.3±7.8) years old were included. According to the gold standard of surgical pathological diagnosis, the patients were divided into benign and malignant groups, comprising 56 and 122 cases, respectively. The differences in ultrasonographic manifestations between the two groups were compared to observe the sampling success and complication rates of ultrasound-guided needle biopsy and to evaluate the sensitivity and specificity of the diagnostic accuracy of this technique in the diagnosis of subpleural lung disease. Positive, negative predictive values and 95% confidence interval(CI) were obtained.Results No statistically significant difference in the comparison of baseline data, such as gender and age, was found between the two groups (all P values＞0.05). Statistically significant differences were found in the ultrasonographic manifestations of the lesions between the two groups in morphology, i.e., presence of air bronchial sign, blood flow signal, and others (all P values＜0.05), although no statistically significant differences were found in lesion sides and boundary and internal echo (all P values＞0.05). The success rate of ultrasound-guided puncture biopsy was 96.07% (171/178), and the complication rate was 3.31%. The diagnostic accuracy was 93.82% (95% CI 89.21%-96.88%). The sensitivity was 90.98% (95% CI 84.44%-95.41%). The specificity was 100% (95% CI 92.32%-100.00%). The positive predictive value was 100% (95% CI 95.98%-100.00%). The negative predictive value was 83.58% (95% CI 72.77%-90.75%).Conclusions The ultrasound findings of subpleural pulmonary lesions can provide certain diagnostic information for the differentiation of benign and malignant lesions. The ultrasound-guided needle biopsy has the advantages of real-time observation, low complication rate, and high diagnostic accuracy. It is useful for subpleural lung diseases, the diagnosis of which has important clinical value.

Key words： Ultrasonography Subpleural pulmonary disease Biopsy, needle

收稿日期: 2021-02-06

基金资助:安徽省高校自然科学基金(KJ2020A0582)

通讯作者: 孙医学,Email: 13309621158@163.com

引用本文:

路明宇, 都晓英, 李阳, 张雷, 苏蕾, 郭婕, 侯迎迎, 朱敏, 郭飞飞, 孙医学. 超声引导穿刺活检在胸膜下肺部疾病诊断中的应用价值[J]. 中华解剖与临床杂志, 2021, 26(6): 623-627.
Lu Mingyu, Du Xiaoying, Li Yang, Zhang Lei, Su Lei, Guo Jie, Hou Yingying, Zhu Min, Gou Feifei, Sun Yixue. Application value of ultrasound-guided percutaneous puncture biopsy in the diagnosis of subpleural pulmonary lesions. Chinese Journal of Anatomy and Clinics, 2021, 26(6): 623-627.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20210206-00036 或 http://www.cjac.com.cn/CN/Y2021/V26/I6/623

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