Objective To discuss the safety and clinical significance of CT-guided percutaneous puncturing biopsy of subcarinal lymph node. Methods During the period of July 2006-July 2010, CT-guided percutaneous puncturing biopsy of subcarinal lymph node was carried out in 17 patients (11 males and 6 females. with an average age of 54 years) with enlarged subcarinal lymph nodes. The clinical data were retrospectively analyzed. Immediately after the puncturing procedure was completed, CT scanning was performed to observe if there was any complications and to evaluate the safety of puncturing biopsy. Biopsy specimens were sent for pathological examination to assess the puncturing accuracy and to make the pathologic diagnosis. The clinical usefulness of this technique was evaluated. Results Of the total 17 cases,successful puncturing into the enlarged subcarinal lymph nodes with single procedure was achieved in 14 and sufficient tissue sample was obtained. The biopsy failed in three cases at initial puncturing procedure as the needle could not be placed into the enlarged subcarinal lymph nodes, the puncturing biopsy had to be given up in two patients because of hemoptysis and in another patient the second puncturing biopsy performed one week later was successful. The total technical successful rate was 88.2％ (15/17). Of the fifteen cases with successful puncturing, definitive pathological diagnosis was obtained in 13 and the diagnosis was uncertain in the remaining two, with a diagnostic positive rate of 86.7％ (13/15). Pathologically, the diagnoses included metastatic lymphadnopathy from lung cancer (n = 10) , proliferative inflammatory lymphadnopathy (n = 2) and tuberculous enlargement of lymph nodes (n = 1). Complications occurred in 4 patients (23.5％, 4/17) ,which mainly were pneumothorax and pulmonary hemorrhage. Conclusion With high successful rate and diagnostic accuracy, CT-guided percutaneous puncturing biopsy of subcarinal lymph node is a safe and effective technique if the operator can well master the manipulation, which is very helpful in guiding the clinical treatment. (J Intervent Radiol, 2011 , 20 : 310-313)%目的 探讨CT引导下隆突下淋巴结穿刺活检的安全性及其临床应用价值.方法 回顾性总结2006年7月 - 2010年7月17例CT引导下隆突下肿大淋巴结穿刺活检的病例资料,穿刺结束后即时CT复查及短期随访,了解并发症情况,评估穿刺安全性.活检标本行病理学检查,评估穿刺活检准确性及其临床应用价值.结果 17例患者中14例首次穿刺活检针即准确进入隆突下淋巴结内,并获得组织学标本;3例首次穿刺活检针未能进入隆突下淋巴结内,其中2例因患者咯血,放弃活检术,1例于1周后行第2次穿刺成功.本组技术成功率为88.2%(15/17).15例穿刺成功者中13例获得病理学诊断,2例未能定性,本组病理活检阳性率86.7%(13/15例),其中肺癌转移性淋巴结10例,炎性反应性增生性淋巴结2例,结核1例.主要并发症有气胸和肺出血,其中2例咯血量较大,给予消炎和止血治疗后症状消失,并发症发生率23.5%(4/17例).结论 CT引导下经皮隆突下淋巴结穿刺活检术成功率和准确性高,在熟练掌握穿刺技术的基础上,按照分布法操作安全性好,对指导临床治疗有很大帮助.
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