대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제65권4호
  • /
  • Pages.373-379
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  • 2011
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지

CT 투시촬영 유도하 중심부바늘생검을 이용한 폐 소결절($\leq$ 20 mm)의 진단

CT Fluoroscopy-Guided Core Biopsy for Diagnosis of Small ($\leq$ 20 mm) Pulmonary Nodules

  • 이혜란 (고려대학교 의과대학 구로병원 영상의학과학교실) ;
  • 김윤경 (고려대학교 의과대학 구로병원 영상의학과학교실) ;
  • 우옥희 (고려대학교 의과대학 구로병원 영상의학과학교실) ;
  • 용환석 (고려대학교 의과대학 구로병원 영상의학과학교실) ;
  • 강은영 (고려대학교 의과대학 구로병원 영상의학과학교실) ;
  • 김현구 (고려대학교 의과대학 구로병원 흉부외과학교실) ;
  • 신봉경 (고려대학교 의과대학 구로병원 병리과학교실)
  • Lee, Hye-Larn (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Kim, Yoon-Kyung (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Woo, Ok-Hee (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Yong, Hwan-Seok (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Kang, Eun-Young (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Kim, Hyun-Koo (Department of Thoracic Surgery, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Shin, Bong-Kyung (Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine)
  • 발행 : 2011.10.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 폐 소결절($\leq$ 20 mm)의 진단에 있어 CT 투시촬영 유도하 중심부바늘생검의 유용성에 대해 알아보고자 하였다. 대상과 방법: 폐 소결절($\leq$ 20 mm)에 대하여 CT 투시촬영 유도하 중심부바늘생검을 시행 받은 62명의 환자를 대상으로 진단적 정확도와 합병증에 대해 알아보았다. 조직검사 결과와 수술(n = 35) 또는 추적검사(n = 27)로 확인된 최종 결과를 비교하여 진단적 정확도를 계산하였으며, 진단적 정확도는 소결절의 크기($\leq$ 10 mm 대 > 10 mm)와 결절의 밀도(고형결절 대 아 고형결절)에 따라 차이가 있는지 알아보았다. 결과: 최종적으로 39명의 환자에서 악성 또는 전암 병소가 확인되었다. CT 투시촬영 유도하 중심부바늘생검을 통해 이중 36명은 진양성, 3명은 가음성으로 나왔다(민감도, 92%). 23명의 환자들은 양성 병소로 밝혀졌으며 가양성 결과는 없었다(특이도, 100%). CT 투시촬영 유도하 폐 결절 중심부바늘생검의 진단적 정확도는 95%였다. 10 mm 이하의 폐 결절의 민감도와 진단적 정확도는 각각 85%와 91%였으며, 10 mm보다 큰 폐 결절의 민감도와 진단적 정확도는 각각 96%와 97%였다(p > 0.05). 고형 폐 결절의 민감도와 진단적 정확도는 각각 93%와 96%였으며, 아 고형 폐 결절의 민감도와 진단적 정확도는 각각 90%와 92%였다(p > 0.05). 17명의 환자(27%)에서 기흉이 발생하였으며 이 중 2명(3%)은 흉강 배액관 삽입을 시행하였다. 결론: CT 투시촬영 유도하 중심부바늘생검은 폐 소결절($\leq$ 20 mm) 진단에 있어 비교적 정확하고 안전한 검사이다.

Purpose: To evaluate the efficacy of CT fluoroscopy-guided core biopsy of small pulmonary nodules. Materials and Methods: This study included 62 patients (35 men, 27 women; age range, 36-85 years) that had a small ($\leq$ 20 mm) pulmonary nodule and underwent CT fluoroscopy-guided core biopsy. The overall diagnostic accuracy and complication rate were calculated. The diagnostic accuracy was compared between two groups according to the nodule size ($\leq$ 10 mm vs. > 10 mm), and nodule density (solid vs. subsolid). Results: Malignant or premalignant lesions were finally diagnosed in 39 patients; 36 true-positive and three false-negative findings (sensitivity, 92%). A benign lesion was finally diagnosed in 23 patients, with no false-positive results (specificity, 100%). The overall diagnostic accuracy was 95%. The sensitivity and diagnostic accuracy were 85% and 91% for nodules $\leq$ 10 mm, and 96% and 97% for nodules > 10 mm (p > 0.05). The sensitivity and diagnostic accuracy were 93% and 96% in the solid group and 90% and 92% in the subsolid group (p > 0.05). Seventeen (27%) patients had a pneumothorax and two (3%) required a closed thoracostomy. Conclusion: CT fluoroscopy-guided core biopsy of small pulmonary nodules yields high diagnostic accuracy with acceptable complication rates.

키워드

참고문헌

  1. Kaneko M, Eguchi K, Ohmatsu H, Kakinuma R, Naruke T, Suemasu K, et al. Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography. Radiology 1996;201:798-802
  2. Sone S, Takashima S, Li F, Yang Z, Honda T, Maruyama Y, et al. Mass screening for lung cancer with mobile spiral computed tomography scanner. Lancet 1998;351:1242-1245 https://doi.org/10.1016/S0140-6736(97)08229-9
  3. Henschke CI, McCauley DI, Yankelevitz DF, Naidich DP, McGuinness G, Miettinen OS, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999;354:99-105 https://doi.org/10.1016/S0140-6736(99)06093-6
  4. Sobue T, Moriyama N, Kaneko M, Kusumoto M, Kobayashi T, Tsuchiya R, et al. Screening for lung cancer with low-dose helical computed tomography: anti-lung cancer association project. J Clin Oncol 2002;20:911-920 https://doi.org/10.1200/JCO.20.4.911
  5. Westcott JL. Direct percutaneous needle aspiration of localized pulmonary lesions: result in 422 patients. Radiology 1980;137:31-35 https://doi.org/10.1148/radiology.137.1.7422857
  6. Khouri NF, Stitik FP, Erozan YS, Gupta PK, Kim WS, Scott WW Jr, et al. Transthoracic needle aspiration biopsy of benign and malignant lung lesions. AJR Am J Roentgenol 1985;144:281-288 https://doi.org/10.2214/ajr.144.2.281
  7. Stanley JH, Fish GD, Andriole JG, Gobien RP, Betsill WL, Laden SA, et al. Lung lesions: cytologic diagnosis by fine-needle biopsy. Radiology 1987;162:389-391 https://doi.org/10.1148/radiology.162.2.3797651
  8. Westcott JL. Percutaneous transthoracic needle biopsy. Radiology 1988;169:593-601 https://doi.org/10.1148/radiology.169.3.3055026
  9. Kim TJ, Lee JH, Lee CT, Jheon SH, Sung SW, Chung JH, et al. Diagnostic accuracy of CT-guided core biopsy of ground-glass opacity pulmonary lesions. AJR Am J Roentgenol 2008;190:234-239 https://doi.org/10.2214/AJR.07.2441
  10. Yamagami T, Iida S, Kato T, Tanaka O, Toda S, Kato D, et al. Usefulness of new automated cutting needle for tissue-core biopsy of lung nodules under CT fluoroscopic guidance. Chest 2003;124:147-154 https://doi.org/10.1378/chest.124.1.147
  11. Katada K, Kato R, Anno H, Ogura Y, Koga S, Ida Y, et al. Guidance with real-time CT fluoroscopy: early clinical experience. Radiology 1996;200:851-856 https://doi.org/10.1148/radiology.200.3.8756943
  12. Moore EH. Technical aspects of needle aspiration lung biopsy: a personal perspective. Radiology 1998;208:303-318 https://doi.org/10.1148/radiology.208.2.9680552
  13. 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;21:232-239 https://doi.org/10.1007/s00330-010-1936-y
  14. Hiraki T, Mimura H, Gobara H, Iguchi T, Fujiwara H, Sakurai J, et al. CT fluoroscopy-guided biopsy of 1,000 pulmonary lesions performed with 20-gauge coaxial cutting needles: diagnostic yield and risk factors for diagnostic failure. Chest 2009;136:1612-1617 https://doi.org/10.1378/chest.09-0370
  15. Montaudon M, Latrabe V, Pariente A, Corneloup O, Begueret H, Laurent F. Factors influencing accuracy of CT-guided percutaneous biopsies of pulmonary lesions. Eur Radiol 2004;14:1234-1240
  16. Li H, Boiselle PM, Shepard JO, Trotman-Dickenson B, McLoud TC. Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules. AJR Am J Roentgenol 1996;167:105-109 https://doi.org/10.2214/ajr.167.1.8659351
  17. Kirchner J, Kickuth R, Laufer U, Schilling EM, Adams S, Liermann D. CT fluoroscopy-assisted puncture of thoracic and abdominal masses: a randomized trial. Clin Radiol 2002;57:188-192 https://doi.org/10.1053/crad.2001.0716
  18. Yeow KM, Su IH, Pan KT, Tsay PK, Lui KW, Cheung YC, et al. Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. Chest 2004;126:748-754 https://doi.org/10.1378/chest.126.3.748
  19. Laurent F, Latrabe V, Vergier B, Montaudon M, Vernejoux JM, Dubrez J. CT-guided transthoracic needle biopsy of pulmonary nodules smaller than 20 mm: results with an automated 20-gauge coaxial cutting needle. Clin Radiol 2000;55:281-287 https://doi.org/10.1053/crad.1999.0368