丹麦半硬性胸腔镜检查在渗出性胸腔积液中的诊断准确性及安全性

Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions in Denmark.

作者信息

Willendrup Fatin, Bodtger Uffe, Colella Sara, Rasmussen Daniel, Clementsen Paul F

机构信息

*Department of Internal and Pulmonary Medicine, Naestved Hospital, Naestved †Institute of Regional Health Research, University of Southern Denmark, Odense ‡Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark.

出版信息

J Bronchology Interv Pulmonol. 2014 Jul;21(3):215-9. doi: 10.1097/LBR.0000000000000088.

DOI:10.1097/LBR.0000000000000088

PMID:24992129

Abstract

BACKGROUND

To assess the diagnostic accuracy and the safety of medical thoracoscopy (MT) performed with the semirigid thoracoscope.

METHODS

We retrospectively evaluated patients who underwent MT with semirigid thoracoscope under local anesthesia for unexplained exudative pleural effusion from March 1, 2009 to September 1, 2013 in Denmark.

RESULTS

Sixty-nine patients were retrospectively studied. In 13 patients it was not possible to perform the scheduled MT, in 9 cases due to an insufficient pneumothorax, in 3 due to an insufficient pleural effusion, and in 1 due to a purulent pleuritis. In 56 patients in whom MT was completed, the procedure was diagnostic in 44 cases: malignancy was reported in 26 patients and a benign diagnosis in 18. In the remaining 12 patients a definite diagnosis was not reached, and further testing was required.In an "intention-to-treat analysis" (69 patients in total), the diagnostic accuracy of MT was 63%, the sensitivity for malignancy was 59% [95% confidence interval (CI)=43%-73%], the specificity was 100% (95% CI=86%-100%), and the negative likelihood ratio was 0.41 (95% CI=0.29-0.58). Considering the 56 patients in whom it was possible to complete the procedure, the diagnostic accuracy was 78%, the sensitivity for malignancy was 74% (95% CI=54%-87%), the specificity was 100% (95% CI=83.75%-100%), and the negative likelihood ratio was 0.27 (95% CI=0.15%-0.45%). No mortality was reported.

CONCLUSIONS

MT performed under local anesthesia with a semirigid scope is a simple and safe procedure with an acceptable sensitivity for malignancy.

摘要

背景

评估使用半硬性胸腔镜进行内科胸腔镜检查（MT）的诊断准确性和安全性。

方法

我们回顾性评估了2009年3月1日至2013年9月1日在丹麦因不明原因渗出性胸腔积液在局部麻醉下接受半硬性胸腔镜MT检查的患者。

结果

对69例患者进行了回顾性研究。13例患者无法按计划进行MT检查，9例是由于气胸不足，3例是由于胸腔积液不足，1例是由于脓性胸膜炎。在完成MT检查的56例患者中，该检查在44例中具有诊断价值：报告26例为恶性肿瘤，18例为良性诊断。其余12例患者未得出明确诊断，需要进一步检查。在“意向性治疗分析”（共69例患者）中，MT的诊断准确性为63%，恶性肿瘤的敏感性为59%[95%置信区间（CI）=43%-73%]，特异性为100%（95%CI=86%-100%），阴性似然比为0.41（95%CI=0.29-0.58）。考虑到能够完成该检查的56例患者，诊断准确性为78%，恶性肿瘤的敏感性为74%（95%CI=54%-87%），特异性为100%（95%CI=83.75%-100%），阴性似然比为0.27（95%CI=0.15%-0.45%）。未报告死亡病例。