Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Respirology. 2018 Jul;23(7):714-717. doi: 10.1111/resp.13275. Epub 2018 Feb 27.
Extrapulmonary tuberculosis (EPTB) accounts for ~15% of all TB patients, and TB pleural effusion is the second most common site of EPTB. The diagnosis of pleural TB is challenging due to the pauci-bacillary nature of the disease. Histopathology of thoracoscopically obtained pleural biopsy provides the highest diagnostic yield. The Xpert MTB/RIF assay (Xpert) is a PCR test that can identify both Mycobacterium tuberculosis (MTB) and rifampicin resistance. Currently, there is a lack of clarity regarding the value of Xpert on pleural tissue. We report our experience of using Xpert on thoracoscopic pleural biopsy samples.
We retrospectively reviewed the records of patients who underwent thoracoscopy in our institution over a 1-year period. Relevant clinical details; indications; and results of tests on pleural tissue and fluid, including histopathology, mycobacterial cultures and Xpert, were extracted.
Of the 156 patients who underwent thoracoscopy, 73 (47%) had TB, 66 (42%) malignancy and 17 (11%) other conditions. Histopathology was diagnostic in all the 73 TB patients (100%). The yields of the microbiological tests against histopathology on thoracoscopic biopsy sample and pleural fluid were: pleural tissue Xpert 45%, pleural tissue culture 39%, pleural fluid culture 17% and pleural fluid Xpert 14%. Pleural tissue provided higher yields than fluid in both Xpert and culture (P < 0.05). Pleural tissue Xpert provided a higher yield than culture and substantially improved yield compared with closed pleural biopsy as we previously reported.
Thoracoscopic pleural biopsy results in increased sensitivity on Xpert testing.
肺外结核病（EPTB）约占所有结核病患者的 15%，结核性胸腔积液是第二常见的 EPTB 部位。由于疾病的菌量少，胸腔积液结核的诊断具有挑战性。经胸腔镜获取的胸膜活检的组织病理学提供了最高的诊断率。Xpert MTB/RIF assay（Xpert）是一种可以同时识别结核分枝杆菌（MTB）和利福平耐药的 PCR 检测。目前，关于 Xpert 在胸膜组织上的价值尚不清楚。我们报告了使用 Xpert 检测胸腔镜胸膜活检样本的经验。
我们回顾性分析了在我们机构进行胸腔镜检查的患者记录。提取了相关的临床详细信息；适应证；以及胸腔组织和胸腔积液的检测结果，包括组织病理学、分枝杆菌培养和 Xpert。
在 156 例接受胸腔镜检查的患者中，73 例（47%）患有结核病，66 例（42%）患有恶性肿瘤，17 例（11%）患有其他疾病。所有 73 例结核病患者的组织病理学检查均具有诊断意义（100%）。胸腔镜活检标本和胸腔积液的微生物学检测结果与组织病理学检查的符合率分别为：胸膜组织 Xpert 检测 45%，胸膜组织培养 39%，胸腔积液培养 17%，胸腔积液 Xpert 检测 14%。胸膜组织的 Xpert 和培养检测的阳性率均高于胸腔积液（P<0.05）。我们之前的报告表明，与闭式胸膜活检相比，胸膜组织 Xpert 检测的阳性率更高，且显著提高了检测的阳性率。
胸腔镜胸膜活检可提高 Xpert 检测的敏感性。
