Division of Respirology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Ann Thorac Surg. 2018 Aug;106(2):361-367. doi: 10.1016/j.athoracsur.2018.02.044. Epub 2018 Mar 22.
The study aim is to compare the diagnostic yield, safety, and cost of outpatient awake thoracoscopy (AT) with video-assisted thoracoscopic surgery (VATS) pleural biopsy in undiagnosed pleural effusions.
The diagnostic yield of pleural biopsy performed by AT or VATS in patients with undiagnosed exudative pleural effusions at a tertiary thoracic surgery center in Canada between 2011 and 2015 was retrospectively evaluated. Test sensitivity, specificity, positive predictive value, and negative predictive value were compared. Procedure safety, hospital length of stay, additional pleural-based interventions, and procedure-related costs were compared.
Patients underwent either AT (n = 78) or VATS (n = 99) during the study period. Sensitivity, specificity, positive predictive value, and negative predictive value were 85%, 100%, 100%, and 79% for AT and 93%, 94%, 99%, and 76% for VATS, with no significant difference in diagnostic test performance. There was no difference in the rate of major complications (2 AT [2.6%] versus 4 VATS [4.0%], p = 0.696), minor complications (14 AT [17.9%] versus 16 VATS [16.2%], p = 0.841) or need for additional pleural-based procedures (20 AT [25.6%] versus 18 VATS [18.2%], p = 0.270). The VATS was associated with longer median hospital stay (VATS 3 days [interquartile range: 1 to 4] versus AT 0 days [interquartile range: 0 to 1], z = 6.98, p < 0.001) and a higher procedure-related average cost (VATS Canadian dollars $7,962 [95% confidence interval: $7,134 to $8,790] versus AT Canadian dollars $2,815 [95% confidence interval: $2,010 to $3,620], p < 0.001).
Awake thoracoscopy and VATS have similar diagnostic yield and safety profiles in the assessment of undiagnosed pleural effusions; however, AT is associated with shorter length of stay and lower average per-procedure cost. In the appropriate clinical setting, AT may be the diagnostic test of choice.
本研究旨在比较在加拿大一家三级胸外科中心，对不明渗出性胸腔积液患者行门诊清醒胸腔镜（AT）与电视辅助胸腔镜手术（VATS）胸膜活检的诊断率、安全性和成本。
回顾性评估了 2011 年至 2015 年期间，在加拿大一家三级胸外科中心对不明渗出性胸腔积液患者行 AT 或 VATS 胸膜活检的诊断率。比较了胸膜活检的检测灵敏度、特异性、阳性预测值和阴性预测值。比较了操作安全性、住院时间、额外的胸膜相关干预措施和与操作相关的成本。
研究期间，患者分别行 AT（n=78）或 VATS（n=99）。AT 的灵敏度、特异性、阳性预测值和阴性预测值分别为 85%、100%、100%和 79%，VATS 分别为 93%、94%、99%和 76%，诊断检测性能无显著差异。主要并发症发生率无差异（2 例 AT [2.6%]与 4 例 VATS [4.0%]，p=0.696），小并发症发生率无差异（14 例 AT [17.9%]与 16 例 VATS [16.2%]，p=0.841），或需要额外的胸膜相关操作（20 例 AT [25.6%]与 18 例 VATS [18.2%]，p=0.270）。VATS 与中位住院时间较长相关（VATS 3 天[四分位距：1 至 4]与 AT 0 天[四分位距：0 至 1]，z=6.98，p<0.001），且操作相关平均成本较高（VATS 加拿大元 7962 元[95%置信区间：7134 至 8790]与 AT 加拿大元 2815 元[95%置信区间：2010 至 3620]，p<0.001）。
在评估不明渗出性胸腔积液时，清醒胸腔镜和 VATS 的诊断率和安全性相似；然而，AT 与较短的住院时间和较低的平均每操作成本相关。在适当的临床环境下，AT 可能是首选的诊断检测方法。
