Original
2022-04-24 15:50
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Hu Yang
A classmate's younger brother, 35 years old, went to a chest CT half a month ago because of the vague pain in the left chest wall, and found that there was a 1.8cm lesion in the middle lobe of the left lung. He sent me CT photos and consulted whether to operate, from ct, this lesion does have malignant signs, but it is not 100% sure that it must be a malignant tumor, so it is recommended that he first do a lung puncture biopsy to clarify the pathology. However, as soon as he heard about lung puncture, he refused, saying that others said that the puncture would cause cancer cells to metastasize. No matter how he explained it, he still couldn't reassure himself.
What is a lung aspiration biopsy?
Percutaneous lung aspiration biopsy under CT localization is one of the most common methods for diagnosing diseases in internal medicine. It can be said that more than half of lung mass diseases require lung puncture tests to confirm the diagnosis. It is to use a thin needle or a slightly thicker biopsy gun through the outer skin into the lung lesion for suction or cutting to obtain a living specimen, except for some pain when applying anesthetics.
There was hardly much pain during the whole process.
Many friends are afraid that puncture will cause the spread or metastasis of malignant tumors, but in fact, this worry is superfluous. The needle is now designed like a ballpoint pen, using the refill to take the tumor tissue and retracting it back into the pen holder. The advantage of this design is that in the process of pulling out the needle, it is always in the protective cannula, preventing the "pulling out of the radish to bring out the mud", effectively avoiding the leakage of malignant cells, even if the cannula brings out a few cancer cells will be destroyed by human immune cells.
Some people say that since it is most likely a malignant tumor, why should it be punctured?
Pathological diagnosis is the "gold standard" for cancer diagnosis, so lung aspiration biopsy is of great significance. For suspected lung cancer that can be operated on, the purpose of a lung aspiration biopsy is to further determine whether it is necessarily malignant. Many lung lesions, although CT looks malignant, but with many benign diseases are difficult to distinguish, every year the thoracic surgery department will encounter such cases, thinking that it is lung cancer, surgical pathology is inflammatory pseudotumor, tuberculosis bulb, aspergillus bulb, mechanized pneumonia. Including my friends and relatives of classmates around me, I encountered such a situation. These patients could have had to suffer from surgery or lost a portion of their lung tissue. Therefore, it is sometimes very dangerous to rush to operate.
For inoperable lung masses, although there is local or distant metastasis, it is not known what kind of cancer it is, so it is necessary to pass lung puncture, obtain local tumor tissue, conduct pathological examination, and further immunohistochemistry and genetic testing to guide the formulation of follow-up treatment plans, and can also help judge prognosis and evaluate treatment effects.
Is there a risk of lung puncture?
As an invasive test, there is a certain risk, but the incidence of this risk is low. For example, the intercostal nerve may be damaged during the puncture, the intercostal blood vessels may be damaged, resulting in hemothora, and some lesions after the puncture bleed into the trachea and are coughed up, manifested by blood in the sputum or a small amount of hemoptysis. Second, inattention to sterile procedures can lead to infection and suppuration at the puncture site, which may cause pneumothorax through puncture of the lungs. Pneumothorax is the most common complication, with an incidence of about 10%, most of which are small amounts of pneumothorax that can be absorbed on their own without treatment. The occurrence of pulmonary puncture complications is related to the proficiency of the operator, the number of injections, the sharp angle of the needle at the puncture point pleural incision line, and the factors of emphysema.