关键词: 结核, 肺, 体层摄影术, X线计算机, 活组织检查, 针吸, 诊断, 鉴别

Abstract:

Objective To analyze the relationship of morphology, density and diagnostic positive rate of lesion at the sampling site using CT guided percutaneous pulmonary biopsy, in order to improve its diagnostic accuracy.Methods The data of the relationship between various features of CT imaging and diagnostic positive rates using CT guided percutaneous pulmonary biopsy were analyzed retrospectively in 103 patients with smear and culture negative diagnosis confirmed by pathology or diagnostic antituberculosis treatment admitted in Beijing Chest Hospital, Capital Medical University from January to December 2017. The statistics were processed by IBM SPSS 24.0 software, and the enumeration data were analyzed by χ ² test and the differences were considered significantly when P<0.05. Results According to lesion morphology of CT, the positive rate of lesion biopsy was 33.33% (1/3) in ground glass opacity lesions and were 91.67% (33/36), 94.74% (18/19), 100.00% (21/21) and 75.00% (18/24) in nodule, consolidation, cavity, mass lesion with significant difference statistically in these four lesions (χ ²=8.918,P=0.030). A comparison was made between nodular group and solid group (χ ²=0.174, P=0.677), cavity group (χ ²=1.847,P=0.174), and mass group (χ ²=3.137,P=0.077), when the comparison was made between consolidation group and cavity group (χ ²=1.134,P=0.287), mass group (χ ²=3.031,P=0.082), and the comparison between the cavity group and the mass group (χ ²=8.058,P=0.014), the differences were no significant statistically due to the modified P' more than 0.008. According to lesion density of CT, the positive rate of lesion biopsy was 33.33% (1/3) in mediastinal window unmeasurable group and were 96.88% (31/32), 94.34% (50/53) and 60.00% (9/15) in non-enhancement group with 0-20 HU, non-enhancement or enhancement not obvious group with more than 20 HU, and obvious enhancement group with more than 20 HU with significant differences statistically (χ ²=17.790,P=0.000). A comparison was made between non-enhancement group with 0-20 HU and obvious enhancement group with more than 20 HU with significant difference statistically (χ ²=10.956,P=0.001), and between non-enhancement group or enhancement not obvious group with more than 20 HU and obvious group with more than 20 HU with also significant difference statistically (χ ²=12.005,P=0.001). However, a comparison was made between non-enhancement group with 0-20 HU and non-enhancement or enhancement not obvious group with more than 20 HU without significant difference statistically (χ ²=0.286,P=0.593).According to pathological detection, the diagnosis were confirmed in 33 cases (32.04%, 33/103) using HE staining,in 87 cases (84.47%, 87/103) using acid-fast stain and in 91 cases (88.35%, 91/103) using TB-DNA. The diagnostic accuracy rates were compared between different two groups with significant differences statistically (χ ²=94.084,P=0.001). Conclusion CT-guided percutaneous pulmonary biopsy is of great value in the diagnosis of smear and culture negative pulmonary tuberculosis. The correct sampling according to morphology, density of lesions using this technique can improve the positive rate of puncture biopsy.

Key words: Tuberculosis, pulmonary, Tomography, X-ray computed, Biopsy, needle, Diagnosis, differential