PERKUTANA BIOPSIJA PERIFERNIH LEZIJA PLUĆA VOĐENA SLIKOM: POREĐENJE BIOPSIJE VOĐENE ULTRAZVUKOM I BIOPSIJE VOĐENE KOMPJUTERIZOVANOM TOMOGRAFIJOM
Sažetak
Perkutana biopsija vođena kompjuterizovanom tomografijom (engl. computed tomography – CT) dobro je ustanovljena tehnika za pribavljanje uzoraka iz promena grudnog koša, pluća i medijastinuma. Međutim, zbog prednosti koje ultrazvučno vođena biopsija ima u kontroli procedure u realnom vremenu i odsustva jonizujućeg zračenja, ne treba je potcenjivati. Cilj ove studije, koja je obuhvatila 77 bolesnika (59 muškaraca i 18 žena) sa perifernim promenama pluća, bio je da utvrdi odnos ultrazvučno vođene biopsije i biopsije vođene CT-om upoređivanjem trajanja intervencije, dijagnostičke uspešnosti i stope komplikacija, kao i ispitivanjem njihove povezanosti sa veličinom promena i prečnikom igle.
Histološka dijagnoza je uspešno postavljena obema tehnikama (95,65% kod ultrazvuka (UZ), odnosno 90,32% kod CT-a). Postoji statistički značajna razlika između stope komplikacija i načina vođenja procedure; evidentiran je značajno veći broj svih, a posebno teških komplikacija, kod biopsija vođenih CT-om ‒ 22,58% spram 2,17% (p ˂ 0,001). Procedura vođena CT-om traje znatno duže od one vođene UZ-om (42,48 minuta ± 5,12 minuta naspram 16,80 minuta ± 3,42 minuta). Utvrđeno je da postoji značajna negativna korelacija između veličine lezije i trajanja procedure kod biopsije vođene CT-om: što je manja lezija, to duže traje procedura.
Iako su obe tehnike veoma pouzdane i skoro jednako uspešne u obezbeđivanju adekvatnih uzoraka za postavljanje histološke dijagnoze, s obzirom na veću stopu teških komplikacija i duže trajanje procedure prilikom vođenja CT-om, kod perifernih promena u plućima uvek treba prvo razmotriti biopsiju vođenu UZ-om.
Reference
Brody L, Covey AM, Chapter 22- Percutaneous Biopsy. In: Blumgart LH, Belghiti J, Jarnagin WR, DeMatteo RP, Chapman WC, Büchler MW, Hann LE, D'Angelica M, editors. Surgery of the Liver, Biliary Tract and Pancreas. 4th ed. W.B. Saunders; 2007, p. 354-61.
Chandrasekhar AJ, Reynes CJ, Churchill RJ. Ultrasonically guided percutaneous biopsy of peripheral pulmonary masses. Chest 1976; 70: 627–30. [CrossRef] [PubMed]
Diacon AH, Schuurmans MM, Theron J, Schubert PT, Wright CA, Bolliger CT. Safety and yield of ultrasound assisted transthoracic biopsy performed by pulmonologists. Respiration 2004; 71: 519 22. [CrossRef] [PubMed]
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136: E359–E386. [CrossRef] [PubMed]
Greene R, Szyfelbein WM, Isler RJ, Stark P, Janstsch H. Supplementary tissue-core histology from fine needle aspiration biopsy. AJR Am J Roentgenol 1985; 144(4): 787-92. [CrossRef] [PubMed]
Harter LP, Moss AA, Goldberg HI, Gross BH. CT guided fine needle aspirations for diagnosis of benign and malignant disease. AJR Am J Roentgenol 1983; 140: 363 7. [CrossRef] [PubMed]
Heerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M. Complication rates of CT guided transthoracic lung biopsy: meta-analysis. Eur Radiol 2017; 27(1): 138-48. [CrossRef] [PubMed]
Herman PG, Hessel SJ. The diagnostic accuracy and complications of closed lung biopsies. Radiology 1977; 125: 11 4. [CrossRef] [PubMed]
Khosla R, Rohatgi PK, Seam N. Ultrasound-guided fine needle aspiration biopsy of pleural-based intrathoracic lesions. J Bronchology Interv Pulmonol 2009; 16: 87–90. [CrossRef] [PubMed]
Kim GR, Hur J, Lee SM, Lee HJ, Hong YJ, Nam JE, et al. CT fluoroscopy guided lung biopsy versus conventional CT guided lung biopsy: A prospective controlled study to assess radiation doses and diagnostic performance. Eur Radiol 2011; 21: 232 9. [CrossRef] [PubMed]
Lee MH, Lubner MG, Hinshaw JL, Pickhardt PJ. Ultrasound Guidance Versus CT Guidance for Peripheral Lung Biopsy: Performance According to Lesion Size and Pleural Contact. AJR Am J Roentgenol 2018; 210(3): W110-W117. [CrossRef] [PubMed]
Liao WY, Chen MZ, Chang YL, Wu HD, Yu CJ, Kuo PH, et al. US guided transthoracic cutting biopsy for peripheral thoracic lesions less than 3 cm in diameter. Radiology 2000; 217:685 91. [CrossRef] [PubMed]
Manhire A, Charig M, Clelland C, Gleeson F, Miller R, Moss H, et al.; BTS. Guidelines for radiologically guided lung biopsy. Thorax 2003; 58:920-936. [CrossRef] [PubMed]
Oswald NC, Hinson KF, Canti G, Miller AB. The diagnosis of primary lung cancer with special reference to sputum cytology. Thorax 1971; 26:623 7. [CrossRef] [PubMed]
Rivera MP, Mehta AC, Wahidi MM. Establishing the diagnosis of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence based clinical practice guidelines. Chest 2013; 143 (5 Suppl): e142S 65S. [CrossRef] [PubMed]
Saraogi A. Lung ultrasound: Present and future. Lung India. 2015; 32(3): 250-7. [CrossRef] [PubMed]
Sconfienza LM, Mauri G, Grossi F, Truini M, Serafini G, Sardanelli F, et al. Pleural and peripheral lung lesions: Comparison of US and CT guided biopsy. Radiology 2013; 266:930 5. [CrossRef] [PubMed]
Sheth S, Hamper UM, Stanley DB, Wheeler JH, Smith PA. US guidance for thoracic biopsy: a valu-able alternative to CT. Radiology 1999; 210: 721–726 . [CrossRef] [PubMed]
Swensen SJ. CT screening for lung cancer. AJR Am. J. Roentgenol. 2002; 179 (4): 833–836. [CrossRef]
Yankelevitz DF, Cham MD, Farooqi AO, Henschke CI. CT directed diagnosis of peripheral lung lesions suspicious for cancer. Thorac Surg Clin 2007; 17: 143 58. [CrossRef] [PubMed]
Yeow KM, Tsay PK, Cheung YC, Lui KW, Pan KT, Ghou AS. Factors affecting diagnostic accuracy of CT-guided coaxial cutting needle lung biopsy: retrospective analysis of 631 procedures. J Vasc Interv Radiol 2003; 14:581-88. [CrossRef] [PubMed]
Yildirim E, Kirbas I, Harman A, Ozyer U, Tore HG, Aytekin C et al. CT-guided cutting needle lung biopsy using modified coaxial technique: factors effecting risk of complications. Eur J Radiol 2009; 70:57-60. [CrossRef] [PubMed]
