收稿日期: 2026-06-01
修回日期: 2026-07-01
录用日期: 2026-07-08
网络出版日期: 2026-08-31
基金资助
国家科技重大专项(2023ZD0506303);科技部国家重点研发计划(2024YFA1108902)
Risk management for pulmonary nodule biopsy：Ruijin expert consensus （2026 edition）
Received date: 2026-06-01
Revised date: 2026-07-01
Accepted date: 2026-07-08
Online published: 2026-08-31
低剂量CT筛查作为发现早期肺癌的核心手段，已被大量循证医学证据证实可显著降低肺癌死亡率。通过影像学检查发现的肺结节中仅部分为早期肺癌，因此通过规范化、精准化的活检手段明确其生物学性质，不仅是实现早期确诊的关键基石，更是围术期风险管理与数智化诊疗决策的重要前提。本次共识由上海交通大学医学院附属瑞金医院肺小结节诊治和管理学科群专家组牵头修订，在2022年版基础上，系统整合最新循证医学证据、国内外高质量临床研究、荟萃分析及临床实践反馈，形成全面更新的指导性文件。本共识聚焦经皮经胸穿刺活检（percutaneous transthoracic needle biopsy，PTNB）与经支气管镜肺活检（transbronchial lung biopsy，TBLB）两大核心技术，系统梳理了涵盖术前评估、路径优化、取材规范的标准化操作流程，重点阐述了气胸、出血、胸膜反应、呼吸衰竭、心律失常、空气栓塞及肿瘤种植转移等主要并发症的发生率、危险因素及核心防控策略，尤其针对高风险人群实施分层管理与精细化干预。本次修订强调，肺结节活检已从传统的“经验性操作”全面转向“多模态影像引导+AI辅助+MDT决策”的个体化精准模式，旨在通过标准化流程与多学科协作，在充分保障患者安全的前提下，实现精准诊断。
上海交通大学医学院附属瑞金医院肺小结节诊治和管理学科群专家组 . 肺结节活检术风险管理瑞金专家共识（2026版）[J]. 诊断学理论与实践, 2026 , 25(04) : 419 -432 . DOI: 10.16150/j.1671-2870.2026.04.005
Low-dose CT screening, as a core approach for detecting early lung cancer, has been demonstrated by substantial evidence from evidence-based medicine to significantly reduce lung cancer mortality. Only a proportion of pulmonary nodules detected by imaging examinations are early-stage lung cancers. Therefore, determining their biological characteristics through standardized and precise biopsy procedures is not only the cornerstone of early diagnosis, but also a prerequisite for perioperative risk management and digital-intelligent diagnosis and treatment decision-making. This consensus, revised by the Pulmonary Nodule Diagnosis and Management Disciplinary Group of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, builds upon the 2022 edition by systematically integrating the latest evidence from evidence-based medicine, high-quality clinical studies from China and abroad, meta-analyses, and clinical practice feedback to develop a comprehensively updated guidance document. Focusing on the two core techniques of percutaneous transthoracic needle biopsy (PTNB) and transbronchial lung biopsy (TBLB), the consensus systematically summarizes standardized operational procedures encompassing preoperative assessment, pathway optimization, and sampling protocols. It elaborates on the incidence, risk factors, and core prevention and control strategies for complications, including pneumothorax, blee-ding, pleural reaction, respiratory failure, arrhythmia, air embolism, and tumor seeding and metastasis, with particular emphasis on stratified management and refined interventions for high-risk populations. This revised consensus underscores that pulmonary nodule biopsy has shifted from traditional experience-based procedures to an individualized, precision-driven model integrating multimodal imaging guidance, AI assistance, and multidisciplinary team (MDT) decision-making. Through standardized workflows and multidisciplinary collaboration, it aims to achieve precise diagnosis while fully ensu-ring patient safety.
Key words： Pulmonary nodules; Biopsy; Risk assessment
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