北村 友宏¹, 浜崎 直樹¹, 柴 五輪男¹, 寺本 正治¹, 今井 照彦¹, 空 昭洋², 林田 幸治², 鴻池 義純³, 平井 都始子⁴, 木村 弘⁵

Tomohiro KITAMURA¹, Naoki HAMAZAKI¹, Iwao SHIBA¹, Shoji TERAMOTO¹, Teruhiko IMAI¹, Akihiro SORA², Kouji HAYASHIDA², Yoshizumi KOUNOIKE³, Toshiko HIRAI⁴, Hiroshi KIMURA⁵

¹済生会奈良病院内科, ²済生会奈良病院臨床検査部, ³平成記念病院内科, ⁴奈良県立医科大学中央内視鏡・超音波部, ⁵奈良県立医科大学第2内科

¹Department of Internal Medicine, Saiseikai Nara Hospital, ²Department of Clinical Laboratory, Saiseikai Nara Hospital, ³Department of Internal Medicine, Heisei Memorial Hospital, ⁴Department of Endoscopy and Ultrasound, Nara Medical University, ⁵The Second Department of Internal Medicine, Nara Medical University

キーワード : color Doppler sonography, transthoracic biopsy, thoracic lesion, lung cancer

目的：肺癌診断において以前より超音波誘導下経胸壁生検の有用性が報告されているが，カラードプラ法により病変内の血流を評価することでより安全かつ確実に検査を実施することが可能と考えられる．そこで経胸壁超音波にて描出可能であった胸腔内病変に対し，本法を併用し超音波誘導下生検を施行しその有用性と安全性について検討した．対象と方法：胸腔内病変を有する50例の患者を対象とし，カラードプラ法を併用した超音波誘導下経胸壁生検を施行した．方法は，病変を経胸壁超音波で描出し，カラードプラ法にて病変内の血流を評価し，(1)できるだけ胸壁に近い部位，(2)太い血管を避ける部位，(3)血流の存在する部位，を穿刺目標と設定し生検を施行し病理診断と最終臨床診断を比較した．結果と考察：全50例中，診断に十分な検体が採取されたのは49例（98.0％），そのうち病理検査で悪性所見陽性は37例（75.5％）で最終臨床診断もすべて悪性であった．他の12例（24.5％）は悪性所見陰性であったが，最終臨床診断ではそのうち1例（9.1％）が悪性であった．合併症は血痰1例，気胸1例のみであり，いずれも軽症であった．結論：経胸壁超音波で描出可能な胸腔内病変において，カラードプラ法を併用することにより安全かつ確実に超音波誘導下経胸壁生検を実施できることが示唆された．

Purpose: The usefulness of ultrasound (US)-guided biopsy for diagnosis of lung cancer has been previously reported. It is possible to more safely and reliably perform tests by evaluating the blood flow within the lesion by color Doppler sonography. We investigated the efficacy and safety of US-guided biopsy using color Doppler sonography for visualization of intrathoracic lesions by transthoracic ultrasound. Subjects and Methods: US-guided transthoracic biopsy using color Doppler sonography was performed in 50 patients with thoracic lesions. Ultrasonographic images of thoracic lesions were obtained and the vascular structures in the lesions were evaluated with color Doppler sonography. Biopsy was performed based on the following criteria: (1) located as close as possible to the thoracic wall, (2) regions without large blood vessels, and (3) regions with some blood vessels. The pathological diagnosis was compared with the final clinical diagnosis. Results and Discussion: Sufficient specimens for examination were obtained in 49 out of 50 cases. The pathological diagnosis was malignancy in 37 (75.5%) cases, with the final clinical diagnosis also being malignancy in all of these 37 cases. As for the other 12 cases, the final clinical diagnosis was malignancy in one case (9.1%) and benign in 11 cases (91.7%). One case developed asymptomatic pneumothorax, and one case developed hemosputum. Both were mild and resolved without treatment. Conclusion: The present findings suggest that US-guided transthoracic biopsy for thoracic lesions could be performed safely and accurately using color Doppler sonography.