Sallach Susan M, Sallach John A, Vasquez Eduardo, Schultz Lonni, Kvale Paul
Division of Internal Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
Chest. 2002 Dec;122(6):1913-7. doi: 10.1378/chest.122.6.1913.
To determine if the diagnosis of pleural malignancy is dependent on the volume of pleural fluid sampled.
Single-center retrospective chart review.
Two hundred eighty-two patients who underwent diagnostic thoracentesis between October 1, 1998, and June 30, 1999.
Charts were analyzed for volume of fluid, pathologic and clinical diagnoses, and demographics. Patients were classified into quartiles based on the volume of pleural fluid collected. Sensitivity and negative predictive value (NPV) were calculated for each quartile for diagnosis of pleural malignancy by cytology of pleural fluid. Further analyses were done regarding the effect of sex, race, age, smoking history, and personal history of malignancy on diagnosis.
In total, 374 samples from 282 patients were identified (140 men and 142 women). Pleural malignancy within 6 months of initial thoracentesis was diagnosed in 99 patients (35.1%). No differences were detected for sensitivity and NPV for diagnosis of pleural malignancy between any two quartiles (p > 0.05). Samples collected from women had a higher sensitivity for predicting pleural malignancy (p = 0.0011), and those collected from nonsmokers had a slightly higher but not statistically significant sensitivity for predicting pleural malignancy (p = 0.057). Samples collected from subjects with no history of malignancy had a significantly higher NPV than samples collected from subjects with a history of malignancy (p < 0.001). After adjusting for these demographic and medical history factors, the associations of the pleural fluid volume quartiles with sensitivity and NPV did not change.
The sensitivity for diagnosis of pleural malignancy is not dependent on the volume of pleural fluid extracted during thoracentesis.
确定胸膜恶性肿瘤的诊断是否取决于所采集的胸腔积液量。
单中心回顾性病历审查。
1998年10月1日至1999年6月30日期间接受诊断性胸腔穿刺术的282例患者。
分析病历中的液体量、病理和临床诊断以及人口统计学资料。根据所采集的胸腔积液量将患者分为四分位数。通过胸腔积液细胞学检查计算每个四分位数诊断胸膜恶性肿瘤的敏感性和阴性预测值（NPV）。进一步分析了性别、种族、年龄、吸烟史和恶性肿瘤个人史对诊断的影响。
共识别出来自282例患者的374份样本（140名男性和142名女性）。99例患者（35.1%）在首次胸腔穿刺术6个月内被诊断为胸膜恶性肿瘤。任意两个四分位数之间诊断胸膜恶性肿瘤的敏感性和NPV均未检测到差异（p>0.05）。从女性采集的样本对预测胸膜恶性肿瘤具有更高的敏感性（p = 0.0011），从不吸烟者采集的样本对预测胸膜恶性肿瘤的敏感性略高，但无统计学意义（p = 0.057）。从未有过恶性肿瘤病史的受试者采集的样本NPV显著高于有恶性肿瘤病史的受试者采集的样本（p<0.001）。在调整这些人口统计学和病史因素后，胸腔积液量四分位数与敏感性和NPV的关联未改变。
胸腔穿刺术期间提取的胸腔积液量不影响胸膜恶性肿瘤诊断的敏感性。
