Abstract:

Objective To compare the efficacy and safety of CT and ultrasound-guided percutaneous biopsy of lung or pleural lesions. Methods The clinical data of 193 patients with lung space occupying lesions near the pleura who underwent CT or ultrasound-guided percutaneous puncture in Shiyan People's Hospital Affiliated to Hubei University of Medicine from February 2017 to October 2020 were analyzed retrospectively. According to the puncture mode, the patients were divided into CT-guided group （n=115） and ultrasound-guided group （n=78）. The general clinical data, pathological examination results, puncture success rate and complication rate were compared between the two groups. Logistic regression was used for univariate and multivariate regression analysis. Results The detection rate of malignant tumors in the CT-guided group （60.00%, 69/115） was higher than that in the ultrasound-guided group （50.00%, 39/78）, with no statistically significant difference （χ²=1.89, P=0.170）. The puncture success rate in the CT-guided group （88.70%, 102/115） was slightly lower than that in the ultrasound-guided group （93.59%, 73/78）, with no statistically significant difference （χ²=1.32, P=0.251）. The incidence of postoperative complications in the CT-guided group （18.26%, 21/115） was higher than that in the ultrasound-guided group （6.41%, 5/78）, with a statistically significant difference （χ²=5.60, P=0.018）. The incidence of pneumothorax in the CT-guided group （13.04%, 15/115） was higher than that in the ultrasound-guided group （3.85%, 3/78）, with a statistically significant difference （χ²=4.65, P=0.031）. The incidence rate of bleeding in the CT-guided group （5.22%, 6/115） was higher than that in the ultrasound-guided group （2.56%, 2/78）, with no statistically significant difference （χ²=0.82, P=0.364）. In the CT-guided group, 1 patient （0.87%） had severe bleeding requiring surgical treatment, 5 patients （4.35%） required closed thoracic drainage for treatment. In the ultrasound-guided group, no patients had pneumothorax or bleeding requiring drainage or surgery. Univariate analysis showed that the puncture method was an independent risk factor for the puncture success rate in patients with lesion-pleura contact arc length （LPCAL）≥38 mm （OR=7.82, 95%CI： 1.57-35.50, P=0.039）. Multivariate analysis showed that puncture method is an independent risk factor affecting the puncture success rate in patients with LPCAL≥38 mm （OR=7.75, 95%CI： 1.44-41.36, P=0.042）. Among patients with LPCAL≥38 mm, the puncture success rates of CT- and ultrasound-guided puncture were 84.38% （54/64） and 98.00% （49/50）, respectively, and the puncture success rate of CT-guided puncture was lower than that of ultrasound-guided puncture, with a statistically significant difference （χ²=4.52, P=0.034）. In LPCAL<38 mm patients, the puncture success rates of CT- and ultrasound-guided puncture were 94.12% （48/51） and 85.71% （24/28）, respectively, and the CT-guided puncture success rate was higher than that of the ultrasound-guided puncture, with a statistically significant difference （χ²=0.71, P=0.399）. Conclusion Ultrasound-guided percutaneous puncture biopsy of lung or pleural lesions has the advantages of high diagnostic rate and few complications. Both ultrasound-guided and CT-guided puncture biopsy are feasible methods for puncture of chest wall lesions. When LPCAL≥38 mm, ultrasound-guided puncture biopsy may have more advantages.

Key words: Lung disease, Biopsy, needle, Tomography, X-ray computed, Ultrasonography