CT引导下胸内病变细针穿刺细胞学检查

Sridhar Pulluri, Ramulu Madire
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摘要

摘要背景:胸腔内肿块的诊断对临床医生来说是一项艰巨的挑战。纵隔解剖结构紧凑,病变多样。本研究旨在确定计算机断层扫描(CT)引导的细针抽吸细胞学(FNAC)在评估各种胸部肿块病变中的效率。方法:共有46名患者在增强CT上确认为胸部肿块病变。使用市售的CT(Ingenuity 128切片,Philips)进行活检。所有患者均接受了详细的临床病史和体格检查。调查:所有病例的全血细胞计数、红细胞沉降率、出血时间、凝血时间、凝血酶原时间、活化部分凝血活酶时间、HIV和HbsAg、胸部X光前后视图和侧视图。在需要的地方进行胸部X光AP检查和超声检查。所有病例在FNAC前均行平扫和对比CT检查。结果:在我们的研究中,46例患者中有45例(97.82%)具有阳性诊断率;恶性肿瘤的阳性率为89.13%(41/46),良性为8.69%(4/46),未确诊为1/46(2.17%),其中40例(86.96%)为实质性病变,6例(13.04%)为纵隔病变。在40个实质性病变中,38/40(95%)为恶性,其中鳞状细胞癌占55.3%,腺癌占28.9%。结论:FNAC可用于获取样本,用于诊断局灶性肺部感染,即使是免疫功能低下的患者,并可用于规划癌症和转移病灶的适当化疗方案。CT引导下的FNAC是诊断20毫米以下肺部小结节的初步方法,有助于早期诊断和治疗干预,改善预后。
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Computed Tomography (CT)guided Fine Needle Aspiration Cytology of Intrathoracic Lesions
Abstract B ackground: Diagnosis of intrathoracic masses is a difficult challenge for clinicians. The compact anatomical arrangement of the mediastinum with diverse pathologies is usually encountered. The present study was done to determine the efficiency of computed tomography (CT) guided Fine-Needle Aspiration Cytology (FNAC) in the evaluation of various thoracic mass lesions Methods : A total of n=46 patients presenting as intrathoracic mass lesions, confirmed on contrast-enhanced CT, were included in the study. A commercially available CT (Ingenuity 128 slices, Philips) was used for biopsy. All patients were subjected to detailed clinical history and physical examination. Investigations: Complete blood count, Erythrocyte sedimentation rate, bleeding time, clotting time, Prothrombin time, Activated partial thromboplastin time, HIV and HbsAg, Chest X-ray postero Anterior view, and Lateral view done in all cases. Chest X-ray AP view and Ultrasound was done wherever needed. Plain and contrast CT was done in all cases before FNAC. Results: The positive diagnostic yield in our study is noted in 45 of the 46 patients(97.82%); the positive yield for malignancy was 89.13% (41 of 46 patients), benign in8.69 % (4/46), and undiagnosed in 1/46 (2.17%). Out of 46, 40(86.96%) were parenchymal lesions and 6(13.04%) were mediastinal lesions. Out of 40 parenchymal lesions, 38/40(95%) were malignant, which consisted of 55.3% Squamous cell carcinoma, 28.9% Adenocarcinoma. Conclusion: FNAC is useful for obtaining samples for the diagnosis of focal pulmonary infections, even in immunocompromised patients, and planning appropriate chemotherapy options in lung cancer and metastatic lesions.CT-guided FNAC is an initial approach for the diagnosis of small pulmonary nodules of less than 20mm, aiding in early diagnosis and treatment interventions improving prognosis.
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