Divisione di Pneumologia, Spedali Civili, Brescia, Italy.
J Thorac Oncol. 2012 Mar;7(3):595-8. doi: 10.1097/JTO.0b013e31823e0667.
Malignant pleural mesothelioma (MPM) is an aggressive malignancy arising from mesothelial cells lining the pleura. Most commonly, it presents as a unilateral pleural effusion. MPM usually develops on the parietal pleural surface and later spreads to the visceral pleura. Visceral pleural involvement entails a more advanced disease stage and is therefore an important prognostic factor. Pleural fluid (PF) cytology is often the first diagnostic test, but the sensitivity in the literature varies from 4 to 77%. However, no data are available for the diagnostic yield of cytological PF analysis with regard to the visceral pleural involvement. The aim of this study is to assess whether PF cytological yield is related to the extent and pattern of visceral pleural invasion, as assessed by thoracoscopy.
Medical records of all patients who underwent thoracoscopy for suspicion of malignant pleural effusion from two hospitals were reviewed. Patients were selected if they initially underwent a diagnostic thoracentesis before thoracoscopy, if visceral pleural appearance during thoracoscopy was clearly documented, and MPM confirmed on pleural tissue biopsy.
Seventy-five patients were selected. Forty-five patients had a positive PF cytology on thoracentesis, while 30 had a negative PF cytology. Thoracoscopy showed parietal pleural invasion in all subjects. Interestingly, 82% of patients with positive PF cytology on thoracentesis had visceral pleural involvement, whereas only 30% of those with negative PF cytology had visceral pleural invasion. The pattern of visceral pleural invasion consisted of pleural masses, nodules, or pleural thickening. A multivariate regression identified visceral pleural invasion (p < 0.001) as the only independent factor predicting the positivity of cytology on pleural effusion.
In epithelioid MPM, PF cytological yield was significantly higher in patients with visceral pleural invasion assessed by thoracoscopy. Positive PF cytology is associated with a more advanced disease.
恶性胸膜间皮瘤（MPM）是一种来源于胸膜间皮细胞的侵袭性恶性肿瘤。最常见的表现是单侧胸腔积液。MPM 通常发生在壁层胸膜表面，随后扩散到脏层胸膜。脏层胸膜受累意味着疾病处于更晚期，因此是一个重要的预后因素。胸腔积液（PF）细胞学检查通常是首选的诊断测试，但文献中的敏感性在 4%至 77%之间变化。然而，尚无关于脏层胸膜受累的 PF 细胞学分析的诊断收益的数据。本研究旨在评估 PF 细胞学检查的检出率是否与胸腔镜评估的脏层胸膜侵犯的程度和模式有关。
回顾了两家医院因恶性胸腔积液怀疑而接受胸腔镜检查的所有患者的病历。选择了以下患者：如果他们在胸腔镜检查前最初接受了诊断性胸腔穿刺术，如果胸腔镜检查期间脏层胸膜外观清楚记录，并且胸膜组织活检证实为间皮瘤。
共选择了 75 例患者。45 例胸腔穿刺 PF 细胞学检查阳性，30 例 PF 细胞学检查阴性。所有患者均有胸腔镜下壁层胸膜侵犯。有趣的是，胸腔穿刺 PF 细胞学检查阳性的患者中有 82%存在脏层胸膜受累，而 PF 细胞学检查阴性的患者中只有 30%存在脏层胸膜侵犯。脏层胸膜侵犯的模式包括胸膜肿块、结节或胸膜增厚。多变量回归确定脏层胸膜侵犯（p<0.001）是预测胸腔积液细胞学检查阳性的唯一独立因素。
在上皮样 MPM 中，胸腔镜评估存在脏层胸膜侵犯的患者中 PF 细胞学检查的阳性率显著更高。PF 细胞学检查阳性与疾病更晚期有关。
