Biópsia percutânea transtorácica guiada por TC na avaliação de lesões pulmonares de natureza indeterminada

 

CT-guided percutaneous transthoracic biopsy in the evaluation of undetermined pulmonary lesions

 

 

Rute Lourenço ¹

Rui Camacho ¹

Maria João Barata ¹

Dolores Canário ²

Augusto Gaspar ³

Carlos Cyrne ⁴

 

 

Resumo

Avaliação retrospectiva das biópsias percutâneas transtorácicas (BPTT) guiadas por TC de lesões pulmonares indeterminadas, realizadas no Serviço de Radiologia do Hospital Garcia de Orta entre 2002 e 2004. Realizaram-se 89 biópsias aspirativas (BA) e 13 biópsias core (BC) a 92 doentes (67 homens, idade média 64,4 anos). Oitenta e duas lesões (89%) corresponderam a lesões nodulares (diâmetro médio: 3,8±1,7cm, 65 periféricas). Não obtivemos complicações nas BC. Ocorreram complicações minor em 11 BA e um caso de pneumotórax com necessidade de drenagem. Setenta e duas BA foram adequadas para diagnóstico citológico, positivo para células neoplásicas em 72% dos casos. Em todas as BC a amostra foi adequada e conclusiva. Das 7 BC realizadas a doentes com BA, 3 permitiram uma melhor caracterização histológica e, em 3, a BC permitiu o diagnóstico histológico. Todos os diagnósticos malignos corresponderam a lesões nodulares: adenocarcinoma (n=20), carcinoma de não pequenas células pouco diferenciado (n=13), epidermóide (n=10), de pequenas células (n=5), tumor carcinóide (n=2), carcinoma bronquíolo-alveolar (n=1), esotelioma maligno (n=1) e metástases (n=8). As alterações inflamatórias/inespecíficas (n=5) foram as lesões benignas mais frequentes. A idade (p=0,007) e o diâmetro da lesão (p=0,006) foram superiores nos nódulos malignos. Os contornos espiculados e lobulados (p=0,05) foram mais prevalentes nas lesões malignas e os contornos regulares nas benignas (p=0,0001). Não se verificou diferença estatisticamente significativa relativamente ao sexo, tabagismo, localização, cauda pleural, atenuação homogénea, cavitação, calcificações, necrose e broncograma aéreo.

Concluiu-se que a BPTT guiada por TC é uma técnica segura e eficaz na avaliação de l esões pulmonares indeterminadas.

Palavras-chave: Biópsia percutânea transtorácica, tomografia computorizada, lesões pulmonares indeterminadas.

 

Abstract

CT-guided Percutaneous Transthoracic Biopsies (PTB) performed in the Radiology Department of Garcia de Orta Hospital between 2002 and 2004 to evaluate undetermined pulmonary lesions were retrospectively analysed. 89 fine needle aspiration biopsies (FNAB) and 13 core needle biopsies (CNB) were performed on 92 patients (67 men, mean age: 64.4 years). 82 lesions (89%) were nodular lesions (mean diameter: 3.8±1.7 cm, 65 peripheral). We did not observe complications among patients who underwent CNB; minor complications and pneumothorax requiring drainage occurred in 11 FNAB. 72 FNAB were considered adequate for cytology diagnosis; 72% of them positive for malignancy. All CNB were adequate and conclusive. From the 7 CNB performed on patients with previous FNAB, 3 allowed a better histological characterization and in 3 cases of inadequate FNAB, CNB was conclusive. All malignant lesions were nodules: 20 adenocarcinoma, 13 non-small cell lung cancer (SCLC), 10 epidermoid tumours, 5 small-cell lung cancer, 2 carcinoids, 1 bronchiolo alveolar carcinoma, 1 malignant mesothelioma and 8 metastasis. Unspecific/inflammatory lesions (n=5) were the most frequent benign lesions. Malignant lesions were more prevalent in older patients (p=0.007) and were larger (p=0.006). Spiculated and lobulated contour (p=0.05) were more prevalent in malignant lesions while regular contour was more frequent among benign lesions (p=0.0001). Gender, smoking, location, pleural tag, homogenous attenuation, cavitation, calcification, necrosis and air bronchogram did not differ significantly between benign and malignant nodules.

This study shows that CT-guided PTB is a safe and effective procedure in the evaluation of undetermined pulmonary lesions.

Key-words: Percutaneous transthoracic biopsy, computed tomography, undetermined pulmonary lesions.

 

 

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¹ Interno/a de Radiologia, Serviço de Radiologia (Director: Dr. Carlos Cyrne) / Radiology intern, Radiology Unit

² Assistente Graduada de Pneumologia, Serviço de Pneumologia (Director: Dr. Jorge Roldão Vieira) / Graduate Pulmonology Assistant, Pulmonology Unit

³ Assistente Graduado de Radiologia, Serviço de Radiologia (Director: Dr. Carlos Cyrne) / Graduate Radiology Assistant, Radiology Unit

⁴ Director do Serviço de Radiologia do HGO / Director, Radiology Unit, HGO

Hospital Garcia de Orta, SA, Almada, Portugal

 

Recebido para publicação/received for publication: 06.05.09

Aceite para publicação/accepted for publication: 06.06.20