《2003BTS X线引导下肺穿刺活检指南》内容预览

FORMULATION OF GUIDELINES
Validity and grading of recommendations
The criteria for assessing the levels of evidence and grading of recommendations were based on those recommended in the Scottish Inter- collegiate Guidelines Network in 1995 using the Agency of Health Care Policy and Research model used in some other BTS guidelines (tables 1 and 2). It should be noted that there are very few randomised trials comparing the various aspects of lung biopsy and, for that reason, more detailed systems of categorisation such as that of the Scottish Intercollegiate Guidelines Network pub-lished in 2001 were not used.
The papers selected by searching PubMed and Medline were assessed by the members of the working group and decisions on levels of evidence for each paper were made by two or more members. The guidelines were sent for comment to the Royal College of Radiologists, the British Thoracic Society, the British Society of Interventional Radiology, the Royal College of Pathologists, and the Society of Cardiothoracic Surgeons.

Scheduled review of guidelines
As methods of diagnosis and tissue sampling change and new evidence comes to light, the content and evidence base for these guidelines will be reviewed.

TYPES OF LUNG BIOPSY
Lung biopsies may be classified according to the method of access (percutaneously, bronchosco-pically, open operation) or by the reason for biopsy (sampling of diffuse lung disease or obtaining tissue from a mass when malignancy is suspected). Sometimes percutaneous biopsy is also defined by the tissue type obtained (cytolo-gical or histological). The indications for each will be discussed later.
Fine needle aspiration biopsy (FNA, FNAB) gives cytological specimens and, although these needles tend to be of narrow bore, cutting needles (CNB) that produce histological speci-mens can also be of similar gauge. For that reason, lung biopsy in general is referred to as percutaneous transthoracic lung biopsy (PTLB) in these guidelines.

Percutaneous transthoracic lung biopsy
PTLB is performed with imaging guidance and most frequently by a radiologist. Usually the aim is to diagnose a defined mass. Imaging mod-alities are fluoroscopy, computed tomography (CT), and ultrasound. Ultrasound is useful only where the tissue mass is in contact with the chest wall since the ultrasound beam does not pass through air and, hence, the aerated lung. Magnetic resonance imaging (MRI) currently has a limited use because of expense, difficulty accessing the patient within the magnet, the relatively poor visualisation of lung lesions, and difficulties with ferromagnetic instruments within the magnetic field.

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