背景:肺动脉(PA)肿块很少见。区分PA肿瘤和栓塞有时很困难,手术活检既昂贵又危险。我们旨在评估影像引导经皮血管内活检(PEB)获取组织进行组织学诊断的功效。
方法:我们搜索了Cochrane,Medline,Embase,和WebofScience涉及PA肿块患者的PEB试验,从数据库开始到2023年8月发布。
结果:我们回顾性回顾了33项研究,包括87例患者(中位年龄55±69.3岁,44名男性),PA肿块总共接受了110个PEB。在这些病人中,34.5%(n=38)接受PEB导管抽吸术(PEB-CA),50.9%(n=56)接受了PEB钳活检(PEB-FB),2.7%(n=3)接受了PEB定向粥样斑块切除术(PEB-DA)。PA肿块最常见的组织学病因是间充质肿瘤(n=67,75.9%)。肿瘤栓塞(n=6,6.9%)和肺栓塞(n=3,3.4%)是PA肿块的第二和第三常见类型,分别。PEB-CA的技术成功率,PEB-FB和PEB-DA为92.1%,94.6%和100%(p=0.796),分别。组织病理学分析提供的临床诊断成功率为44.7%,PEB-CA为85.7%和100%,PEB-FB和PEB-DA(p<0.001),分别。在成对比较中,PEB-FB的病理诊断成功率高于PEB-CA(p=0.000)。除了一名患有出血性心包填塞的患者外,无其他并发症发生。
结论:影像引导下的PEB是一种安全有效的PA肿块早期病理诊断技术。
BACKGROUND: Pulmonary artery (PA) masses are rare. Distinguishing PA tumours from embolism is sometimes difficult, and surgical biopsy is expensive and risky. We aimed to evaluate the efficacy of imaging-guided percutaneous endovascular biopsy (PEB) for obtaining tissues for histological diagnosis.
METHODS: We searched Cochrane, Medline, Embase, and Web of Science for PEB trials involving patients with PA masses, published from the inception of the database until August 2023.
RESULTS: We retrospectively reviewed 33 studies including 87 patients (median age 55 ± 69.3 years, 44 men) with PA masses who underwent a total of 110 PEBs. Of these patients, 34.5% (n = 38) underwent PEB-catheter aspiration (PEB-CA), 50.9% (n = 56) underwent PEB-forceps biopsy (PEB-FB) and 2.7% (n = 3) underwent PEB-directional atherectomy (PEB-DA). The most common histological aetiology of PA masses was mesenchymal tumours (n = 67, 75.9%). Tumour embolism (n = 6, 6.9%) and pulmonary embolism (n = 3, 3.4%) were the second and third most common types of PA masses, respectively. The technical success rates of PEB-CA, PEB-FB and PEB-DA were 92.1%, 94.6% and 100% (p = 0.796), respectively. Histopathological analysis provided clinical diagnostic success rates of 44.7%, 85.7% and 100% for PEB-CA, PEB-FB and PEB-DA (p < 0.001), respectively. In pairwise comparison, PEB-FB had a higher success rate in pathological diagnosis than PEB-CA (p = 0.000). Apart from one patient suffering from haemorrhagic cardiac tamponade, no other complications occurred.
CONCLUSIONS: Imaging-guided PEB is a safe and effective technique for the early pathological diagnosis of PA masses.