ﺑﺮرﺳﻲ ﻛﺎراﺋﻲ و اﻳﻤﻨﻲ ﺑﻴﻮﭘﺴﻲ ﺳﻮزﻧﻲ از راه ﭘﻮﺳﺖ ﺑﺎ راﻫﻨﻤﺎﻳﻲ ﺳﻮﻧﻮﮔﺮاﻓﻲ در ﺗﺸﺨﻴﺺ ﺗﻮده ﻫﺎي ﻣﺤﻴﻄﻲ رﻳﻪ

The Role of Ultrasonographic Guided Transthoracic Needle Biopsy in Diagnosis of Peripheral Lung Mass

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺑﻴﻮﭘﺴﻲ ﺳﻮﺯﻧﻲ ﺗﺮﺍﻧﺲ ﺗﻮﺭﺍﻛﺴﻴﻚ Transthoracic Needle Biopsy (TTNB)][ ﻳﮏ ﺭﻭﺵ ﻣﻮﺭﺩ ﺗﺄﻳﻴﺪ ﺩﺭ ﺗﺸﺨﻴﺺ ﭘﺎﺗﻮﻟﻮﮊﻳﮏ ﺿﺎﻳﻌﺎﺕ ﺭﻳﻮﻱ ﺑﻮﺩﻩ ﮐﻪ ﺑﺪﻧﺒﺎﻝ ﺍﻧﺠﺎﻡ ﺑﺮﻭﻧﮑﻮﺳﮑﻮﭘﻲ ﻗﺒﻠﻲ ﻗﺎﺩﺭ ﺑﻪ ﺗﺸﺨﻴﺺ ﺿﺎﻳﻌﻪ ﻧﺒﻮﺩﻳﻢ. ﻫﺪﻑ ﺍﺯ ﺍﻧﺠﺎﻡ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺮﺭﺳﻲ ﺍﻳﻤﻨﻲ ﻭ ﺩﻗﺖ ﺗﺸﺨﻴﺺ TTNB ﺑﺎ ﺭﺍﻫﻨﻤﺎﻳﻲ ﺳﻮﻧﻮﮔﺮﺍﻓﻲ ﺩﺭ ﺗﺸﺨﻴﺺ ﺿﺎﻳﻌﺎﺕ ﻣﺤﻴﻄﻲ ﺭﻳﻪ ﻣﻲ ﺑﺎﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﻳﮏ ﻣﻄﺎﻟﻌﺔ ﻣﻘﻌﻄﻲ ﺍﺯ ﻣﻬﺮﻣﺎﻩ ﺳﺎﻝ 84، 30 ﺑﻴﻤﺎﺭ ﺑﺎ ﺗﻮﺩﺓ ﻣﺤﻴﻄﻲ ﺭﻳﻪ ﺑﺎ ﻗﻄﺮ ﺑﻴﺸﺘﺮ ﺍﺯ 3 ﺳﺎﻧﺘﻴﻤﺘﺮ ﮐﻪ ﻓﺎﺻﻠﻪ ﺗﻮﺩﻩ ﺍﺯ ﺟﺪﺍﺭﻩ ﻗﻔﺴﺔ ﺳﻴﻨﻪ ﮐﻤﺘﺮ ﻳﺎ ﻣﺴﺎﻭﻱ 5 ﺳﺎﻧﺘﻴﻤﺘﺮ ﺑﻮﺩﻩ ﺑﺎ ﺭﺍﻫﻨﻤﺎﻳﻲ ﺳﻮﻧﻮﮔﺮﺍﻓﻲ ﺗﺤﺖ ﻧﻤﻮﻧﻪ ﺑﺮﺩﺍﺭﻱ ﺑﺎﻓﺘﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﻭ ﺍﺯ ﻧﻈﺮ ﺩﻗﺖ ﺗﺸﺨﻴﺼﻲ ﻭ ﻋﻮﺍﺭﺽ ﺑﺮﺭﺳﻲ ﺷﺪﻧﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻧﺴﺒﺖ ﻣﺮﺩ ﺑﻪ ﺯﻥ، 2 ﺑﻪ 1 ﺑﻮﺩﻩ ﻭ ﻣﺘﻮﺳﻂ ﺳﻦ ﺑﻴﻤﺎﺭﺍﻥ 61/2 ﺳﺎﻝ ﺑﻮﺩ. ﺍﻏﻠﺐ ﺿﺎﻳﻌﺎﺕ ﺩﺭ ﺳﻤﺖ ﺭﺍﺳﺖ ﻗﺮﺍﺭ ﺩﺍﺷﺘﻨﺪ. ﺩﺭ ﺗﻤـﺎﻣ ﻲ ﺑﻴﻤـﺎﺭﺍﻥ ﻧﻤﻮﻧـﻪ ﮐﺎﻓﻲ ﺟﻬﺖ ﭘﺎﺗﻮﻟﻮﮊﻳﺴﺖ ﺗﻬﻴﻪ ﺷﺪ ﻭﻟﻲ ﺩﺭ 86/6 ﺩﻗﺖ ﺗﺸﺨﻴﺼﻲ ﺩﺍﺷﺘﻪ ﻭ ﺩﺭ 13/3 ﺟﻬﺖ ﺗﺸﺨﻴﺺ ﺩﻗﻴﻖ ﺑﺎﻓﺘﻲ ﻧﻴﺎﺯ ﺑﻪ ﺑﻴﻮﭘﺴﻲ ﺑﺎﺯ ﺭﻳﻪ ﺿﺮﻭﺭﺕ ﻳﺎﻓﺖ. ﺩﺭ ﺑﺮﺭﺳﻲ ﮐﻠﻲ ﭘﺎﺗﻮﻟﻮﮊﻱ 83/3 ﺩﭼﺎﺭ ﺿﺎﻳﻌﻪ ﺑﺪﺧﻴﻢ ﺑﻮﺩﻩ ﮐﻪ ﺷﺎﻳﻌﺘﺮﻳﻦ ﺁﻥ ﺍﺳﻜﻮﺍﻣﻮﺱ ﺳﻞ ﻛﺎﺭﺳﻴﻨﻮﻣﺎ ﻭ ﺁﺩﻧﻮﮐﺎﺭﺳﻴﻨﻮﻣﺎ ﺭﻳﻪ ﺑﻮﺩﻩ ﺍﺳﺖ. ﻭ 16/6 ﺩﭼﺎﺭ ﺿﺎﻳﻌﻪ ﺧﻮﺵ ﺧﻴﻤﻲ ﺑﻮﺩﻩ ﮐﻪ ﺷﺎﻳﻊ ﺗﺮﻳﻦ ﺁﻥ ﮔﺮﺍﻧﻮﻟﻮﻣﺎﺗﻮﺯ ﺳﻠﻲ ﺑﻮﺩﻩ ﺍﺳﺖ. 13/3 ﺑﻴﻤﺎﺭﺍﻥ ﺩﭼﺎﺭ ﻋﺎﺭﺿﻪ ﺷﺪﻧﺪ ﮐﻪ 6/6 ﺩﭼﺎﺭ ﭘﻨﻮﻣﻮﺗﻮﺭﺍﮐﺲ ﻭ 6/6 ﺩﭼﺎﺭ ﻫﻤﻮﭘﺘﺰﻱ ﺷﺪﻧﺪ. ﻣﻮﺭﺩﻱ ﺍﺯ ﻣﺮﮒ ﻭ ﻣﻴﺮ ﺩﺭ ﺍﻳﻦ ﮔﺮﻭﻩ ﻣﺸﺎﻫﺪﻩ ﻧﺸﺪ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺩﻗﺖ ﻣﻨﺎﺳﺐ ﺗﺸﺨﻴﺼﻲ، ﺳﻬﻮﻟﺖ ﺩﺳﺘﺮﺳﻲ، ﺍﺭﺯﺍﻧﻲ ﻭ ﻋﻮﺍﺭﺽ ﻗﺎﺑﻞ ﻗﺒﻮﻝ، ﺗﻮﺻﻴﻪ ﻣﺎ ﺍﻧﺠﺎﻡ TTNB ﺑﺎ ﺭﺍﻫﻨﻤﺎﻳﻲ ﺳﻮﻧﻮﮔﺮﺍﻓﻲ ﺩﺭ ﺗﺸﺨﻴﺺ ﺿﺎﻳﻌﺎﺕ ﻣﺤﻴﻄﻲ ﺭﻳﻪ ﻣﻲ ﺑﺎﺷﺪ.

Introduction & Objective: Transthoracic needle biopsy (TTNB) is a well established method for obtaining pathologic diagnosis in the lung mass that performed after a previous negative bronchoscopy. The gole of this study is the evaluation of safety and accuracy of ultrasonographic guided TTNB for diagnosis of peripheral lung masses. Materials & Methods: In a cross - sectional study from September 2005, 30 patients with peripheral lung mass, greater than 3cm in diameter and less 5cm distance to the chest wall, underwent ultrasonographic guided TTNB and diagnostic accuracy and complications were analyzed. Results: In this group male to female ratio was 2 to one; with average age at 61.2 years. 60% of lesions located in right side, the adequate biopsy specimens were obtained in all patients, but TTNB and diagnostic in 86.6%. 13.3% of patients underwent thoracotomy for definitive diagnosis. Pathological diagnoses were malignant in 83.3% and benign in 16.6% of cases. Squamous Cell Carcinoma and Adenocarcinoma were the most common malignant diagnoses. In benign lesions, tuberculosis was the most common one. Complications were observed in 13.3% that included pneumothorax (6.6%) and hemoptysis (6.6%), mortality wasn’t observed. Conclusions: TTNB with ultrasonographic guided due to appropriate diagnostic accuracy and low complication rate with low cost and availability was recommended for diagnosis of peripheral lung masses