Wang Jinlin, Zhou Xinghua, Xie Xiaohong, Tang Qing, Shen Panxiao, Zeng Yunxiang
Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, 510120, Guangdong Province, China.
Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
BMC Pulm Med. 2016 Nov 17;16(1):155. doi: 10.1186/s12890-016-0318-x.
The most efficient approach to diagnose malignant pleural effusions (MPEs) is still controversial and uncertain. This study aimed to evaluate the utility of a combined approach using ultrasound (US)-guided cutting-needle biopsy (CNB) and standard pleural biopsy (SPB) for diagnosing MPE.
Pleural effusions were collected from 172 patients for biochemical and microbiological analyses. US-guided CNB and SPB were performed in the same operation sequentially to obtain specimens for histological analysis.
US-guided CNB and SPB procedures provided adequate material for histological analysis in 90.7 and 93.0% of cases, respectively, while a combination of the 2 techniques was in 96.5% of cases. The sensitivity, specificity, positive-predictive value (PPV), negative-predictive value (NPV) and diagnostic accuracy of US-guided CNB versus SPB were: 51.2 vs 63.4%, 100 vs 100%, 100 vs 100%, 64.9 vs 72.2% and 74.4 vs 81.3%, respectively. When CNB was combined with SPB, the corresponding values were 88.6, 100, 100, 88.6 and 93.9%, respectively. Whereas sensitivity, NPV and diagnostic accuracy were not significantly different between CNB and SPB, the combination of CNB and SPB significantly improved the sensitivity, NPV and diagnostic accuracy versus each technique alone (p < 0.05). Significant pain (eight patients), moderate haemoptysis (two patients) and chest wall haematomas (two patients) were observed following CNB, while syncope (four patients) and a slight pneumothorax (four patients) were observed following SPB.
Use of a combination of US-guided CNB and SPB afforded a high sensitivity to diagnose MPEs, it is a convenient and safe approach.
诊断恶性胸腔积液（MPE）的最有效方法仍存在争议且尚无定论。本研究旨在评估联合应用超声（US）引导下切割针活检（CNB）和标准胸腔活检（SPB）诊断MPE的效用。
收集172例患者的胸腔积液进行生化和微生物学分析。在同一手术中依次进行US引导下的CNB和SPB，以获取组织学分析标本。
US引导下的CNB和SPB程序分别在90.7%和93.0%的病例中提供了足够的组织学分析材料，而两种技术联合使用则在96.5%的病例中提供了足够材料。US引导下的CNB与SPB相比，其敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和诊断准确性分别为：51.2%对63.4%、100%对100%、100%对100%、64.9%对72.2%和74.4%对81.3%。当CNB与SPB联合使用时，相应的值分别为88.6%、100%、100%、88.6%和93.9%。虽然CNB和SPB之间的敏感性、NPV和诊断准确性无显著差异，但CNB与SPB联合使用相对于单独使用每种技术，显著提高了敏感性、NPV和诊断准确性（p<0.05）。CNB后观察到明显疼痛（8例患者）、中度咯血（2例患者）和胸壁血肿（2例患者），而SPB后观察到晕厥（4例患者）和轻度气胸（4例患者）。
联合使用US引导下的CNB和SPB对诊断MPE具有较高的敏感性，是一种方便且安全的方法。
