【摘要】：目的探討CT引導(dǎo)下經(jīng)皮胸部穿刺活檢(CT-guided transthoracic core needle biopsy, TTNB)在胸部良惡性病變診斷中假陰性結(jié)果的影響因素。材料和方法回顧性分析邵逸夫醫(yī)院2008年1月1日至2013年12月31日期間1339例最終診斷明確病例,收集其中的65例假陰性(不包括2例數(shù)據(jù)丟失病例)和隨機(jī)抽取的106例真陽性TTNB病例的影像學(xué)、臨床及病理資料。采用SPSS 20軟件包進(jìn)行統(tǒng)計學(xué)分析。分析內(nèi)容包括：采用Mann-Whitney U檢驗對兩組間的年齡、病灶大小、病灶深度、針道長度及穿刺角度進(jìn)行比較分析；采用卡方檢驗中的Fisher精確檢驗對兩組間的性別、病灶類型、病灶部位、有無空洞、有無壞死、穿刺體位、是否同軸穿刺、活檢針類型、穿刺次數(shù)及術(shù)中有無氣胸進(jìn)行分析比較；兩組間病灶大小、病灶深度、針道長度及穿刺角度分組間的分析比較,亦采用卡方檢驗中的Fisher精確檢驗。然后采用邏輯回歸分析的方法,對于在單變量分析中有顯著差異的變量進(jìn)行多變量回歸分析來確定假陰性結(jié)果的獨立影響因素。取p0.05為有統(tǒng)計學(xué)差異。結(jié)果1339例中真陽性1237例,真陰性31例,假陽性4例,假陰性67例(包括2例數(shù)據(jù)丟失病例)。TTNB整體診斷準(zhǔn)確性為94.7%(1268/1339),敏感性為94.9%(1237/1304),特異性為88.6%(31/35)；陽性預(yù)測值和陰性預(yù)測值分別為99.7%(1237/1241)和31.6%(31/98)。假陰性組和真陽性組在病灶部位(p=0.005)、病灶大小(p=0.035)、有無壞死(p=0.026)、是否同軸穿刺(p=0.017)、穿刺次數(shù)(p=0.014)、術(shù)中有無氣胸(p=0.020)方面存在統(tǒng)計學(xué)差異,而兩組間年齡(p=0.071)、性別(p=0.631)、病灶類型(p=0.812)、病灶深度(p=0.584)、穿刺體位(p=0.717)、針道長度(p=0.370)、穿刺角度(p=0.156)、活檢針類型(p=0.382)無統(tǒng)計學(xué)差異。在多變量回歸分析中,CT引導(dǎo)下經(jīng)皮胸部穿刺活檢假陰性的獨立影響因素有病灶大小(OR,2.773;95%CI,1.395-5.509;P=0.004)、病灶部位(OR, 0.770;95%CI,0.651-0.911;p=0.002)、是否同軸穿刺(OR,0.245;95%CI,0.101-0.595;p=0.002)。結(jié)論病灶部位、病灶大小、有無壞死、是否同軸、穿刺次數(shù)、術(shù)中有無氣胸是TTNB假陰性結(jié)果的重要影響因素；病灶部位、病灶大小、是否同軸穿刺是假陰性結(jié)果獨立危險因素。
[Abstract]:Objective to investigate the factors influencing the false negative results of CT guided percutaneous transthoracic core needle biopsy, TTNB in the diagnosis of benign and malignant thoracic lesions. Materials and methods A retrospective analysis of 1339 final diagnosed cases from January 1, 2008 to December 31, 2013 in Shaw Hospital was conducted. The imaging, clinical and pathological data of 65 cases of false negative (excluding 2 cases of data loss) and 106 cases of true positive TTNB were collected. SPSS 20 software package was used for statistical analysis. Mann-Whitney U test was used to compare the age, lesion size, lesion depth, needle length and puncture angle between the two groups. The location, cavity, necrosis, position, coaxial puncture, type of biopsy needle, times of puncture and pneumothorax during operation were analyzed and compared between the two groups. Fisher precision test was also used to analyze and compare the needle length and puncture angle groups. Then, by using the method of logical regression analysis, multivariate regression analysis is carried out to determine the independent influencing factors of false negative results for those variables with significant differences in univariate analysis. P0.05 was taken as the statistical difference. Results of the 1339 cases, 1237 were true positive, 31 were true negative, 4 were false positive, 67 were false negative (including 2 data loss cases). The overall diagnostic accuracy of TTNB was 94.7% (1268 / 1339), sensitivity was 94.9% (1237 / 1304), specificity was 88.6% (31 / 35), positive predictive value and negative predictive value were 99.7% (1237r / 1241) and 31.6% (31 / 98), respectively. There were significant differences between the false negative group and the true positive group in lesion location (p0. 005), lesion size (p0. 035), necrosis (p0. 026), coaxial puncture (p0. 017), puncture times (p0. 014), and pneumothorax (p0. 020). There was no significant difference between the two groups in age, sex (p0. 631), lesion type (p0. 812), lesion depth (p0. 584), puncture position (p0. 717), needle length (p0. 370), puncture angle (p0. 156) and biopsy needle type (p0. 382). In multivariate regression analysis, the independent factors influencing the false negative of percutaneous thoracic biopsy under the guidance of multivariate regression were the size of the lesion (OR 2.773 ~ 95 CI 1.395-5.509), the location of the lesion (OR0.651-0.911p0.002), and the coaxial puncture (OR0.245C95CII 0.101-0.595p0. 002). Conclusion the location, size, necrosis, coaxis, times of puncture and pneumothorax during operation are important influencing factors for false negative results of TTNB, and the location, size and coaxial puncture are independent risk factors for false negative results.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R445.1;R56

【共引文獻(xiàn)】

相關(guān)期刊論文 前10條

1 莫科;孟家曉;徐紹斌;楊冠英;秦義柳;;胸部結(jié)節(jié)或腫塊的CT導(dǎo)向穿刺活檢及治療的臨床應(yīng)用[J];當(dāng)代醫(yī)學(xué);2011年14期

2 王敏君;張偉;許飛;梅同華;陳國華;謝世光;肖香佐;;CT引導(dǎo)下經(jīng)皮肺穿刺活檢在不明診斷肺結(jié)節(jié)中的臨床應(yīng)用:附70例報告[J];南方醫(yī)科大學(xué)學(xué)報;2010年07期

3 譚曉明;梁俊生;蔡越飛;曾仲剛;;多層螺旋CT引導(dǎo)下經(jīng)皮肺穿刺活檢的臨床應(yīng)用[J];廣東醫(yī)學(xué);2006年10期

4 陳艷;程雪松;孫洪巖;;CT引導(dǎo)下經(jīng)皮肺穿刺活檢的臨床應(yīng)用[J];安徽醫(yī)學(xué);2015年03期

5 周曉宇;孫耕耘;李偉;丁強(qiáng);陳余清;;內(nèi)科胸腔鏡對結(jié)核性胸腔積液的診斷價值[J];重慶醫(yī)學(xué);2015年22期

6 廖美焱;周云峰;田志雄;張在鵬;徐麗瑩;羅銳;;CT導(dǎo)引下經(jīng)皮肺穿刺切割活檢術(shù)后并發(fā)癥的相關(guān)因素分析[J];武漢大學(xué)學(xué)報(醫(yī)學(xué)版);2009年06期

7 吳生靈;錢慧平;賀明;李志杰;;CT或B超引導(dǎo)下經(jīng)皮肺活檢的特點比較分析[J];中外醫(yī)療;2009年27期

8 許彪;陳剛;韋璐;;多層螺旋CT引導(dǎo)BARD活檢槍經(jīng)皮肺穿刺活檢的臨床應(yīng)用[J];介入放射學(xué)雜志;2009年01期

9 王輝;季洪健;姚秋菊;陳麗萍;張福琛;;CT引導(dǎo)下經(jīng)皮切割肺活檢對彌漫性肺疾病的診斷價值[J];介入放射學(xué)雜志;2009年09期

10 李忠福;朱兆興;呂文濤;陳剛;;CT引導(dǎo)經(jīng)皮肺穿刺活檢的臨床應(yīng)用(附52例報告)[J];當(dāng)代醫(yī)學(xué)(中國介入放射學(xué));2008年04期

相關(guān)碩士學(xué)位論文 前10條

1 段超;CT引導(dǎo)下經(jīng)皮肺穿刺活檢術(shù)對于肺癌的診斷價值[D];中國醫(yī)科大學(xué);2010年

2 吳錫平;血清腫瘤標(biāo)志物及CT引導(dǎo)下經(jīng)皮肺穿刺活檢術(shù)在肺癌診斷中的臨床價值[D];南方醫(yī)科大學(xué);2011年

3 寧鋒鋼;肺部彌漫性結(jié)節(jié)病變的HRCT診斷和鑒別診斷[D];北京市結(jié)核病胸部腫瘤研究所;2007年

4 劉連鳳;超聲引導(dǎo)下經(jīng)皮活檢術(shù)在胸部病變中的臨床應(yīng)用及影響因素分析[D];廣西醫(yī)科大學(xué);2012年

5 錢麒鈺;經(jīng)皮肺穿刺對確定無反應(yīng)性肺炎病原體的臨床分析[D];鄭州大學(xué);2013年

6 姬天洲;CT引導(dǎo)下經(jīng)皮胸部穿刺活檢術(shù)的臨床應(yīng)用及并發(fā)癥防治分析[D];石河子大學(xué);2013年

7 鄭靜;老年人CT引導(dǎo)下經(jīng)皮肺穿刺的安全性及影響因素分析[D];浙江大學(xué);2013年

8 胡亞軍;化療聯(lián)合CT引導(dǎo)下經(jīng)皮微波消融治療晚期非小細(xì)胞肺癌的臨床觀察[D];南昌大學(xué);2014年

9 穆罕默德艾力·阿巴斯;肺部CT和支氣管鏡檢查在診斷肺部病變的臨床價值[D];新疆醫(yī)科大學(xué);2014年

10 陳婧;孤立性肺結(jié)節(jié)良惡性判斷的數(shù)學(xué)預(yù)測模型建立[D];復(fù)旦大學(xué);2013年

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本文編號：2130085