Department of Respiratory Medicine, First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China (mainland).
Department of Respiratory Medicine, The People's Hospital of Huainan, Huainan, Anhui, China (mainland).
Med Sci Monit. 2018 Oct 10;24:7238-7248. doi: 10.12659/MSM.912506.
BACKGROUND Traditional diagnostic methods for tuberculosis (TB) cannot be reliably applied to tuberculous pleurisy. Therefore, this prospective, randomized, controlled trial was performed to compare the diagnostic sensitivity and safety of ultrasound-guided cutting-needle pleural biopsy versus thoracoscopic pleural biopsy in patients suspected of tuberculous pleurisy following inconclusive thoracentesis. MATERIAL AND METHODS A total of 196 adult patients with acid-fast bacillus (AFB)-negative exudative pleural effusions clinically suspected of tuberculous pleurisy were recruited. Enrollees were randomized into 2 cohorts: ultrasound-guided cutting-needle pleural biopsy (n=96) or thoracoscopic pleural biopsy (n=96). The overall diagnostic yields, diagnostic sensitivities for tuberculous pleurisy, and post-procedural complications for both cohorts were statistically compared. RESULTS Ultrasound-guided pleural biopsy displayed an overall diagnostic yield of 83%, while thorascopic pleural biopsy displayed a similar overall diagnostic yield of 86% (χ²=1.88, df=1, p=0.17). There were 127 patients conclusively diagnosed with tuberculous pleurisy, resulting in a tuberculous pleurisy prevalence of 65% in this patient population (66% in the ultrasound cohort vs. 63% in the thoracoscopy cohort; p>0.05). Ultrasound-guided pleural biopsy displayed a sensitivity of 82% in detecting tuberculous pleurisy, while thorascopic pleural biopsy displayed a similar sensitivity of 90% (χ²=1.05, df=1, p=0.30). The sensitivities of these 2 modalities did not significantly differ based on the degree of pleural thickening (p>0.05). Post-procedural complications were minor. CONCLUSIONS Ultrasound-guided and thoracoscopic pleural biopsy both display strong (>80%) but statistically similar overall diagnostic yields for diagnosing pleural effusions following inconclusive thoracentesis. Both modalities also display strong (>80%) but statistically similar sensitivities in detecting tuberculous pleurisy.
传统的结核病（TB）诊断方法不能可靠地应用于结核性胸膜炎。因此，本研究进行了一项前瞻性、随机、对照试验，比较了超声引导下切割针胸膜活检与胸腔镜胸膜活检在胸腔穿刺结果不明确的疑似结核性胸膜炎患者中的诊断敏感性和安全性。
共招募了 196 例临床疑似结核性胸膜炎的抗酸杆菌（AFB）阴性渗出性胸腔积液的成年患者。将患者随机分为 2 组：超声引导下切割针胸膜活检组（n=96）和胸腔镜胸膜活检组（n=96）。统计比较两组的总体诊断率、结核性胸膜炎的诊断敏感性和术后并发症。
超声引导下胸膜活检的总体诊断率为 83%，而胸腔镜胸膜活检的总体诊断率相似，为 86%（χ²=1.88，df=1，p=0.17）。127 例患者被明确诊断为结核性胸膜炎，该患者人群中结核性胸膜炎的患病率为 65%（超声组为 66%，胸腔镜组为 63%；p>0.05）。超声引导下胸膜活检诊断结核性胸膜炎的敏感性为 82%，而胸腔镜胸膜活检的敏感性为 90%（χ²=1.05，df=1，p=0.30）。这两种方法的敏感性在胸膜增厚程度上无显著差异（p>0.05）。术后并发症轻微。
超声引导和胸腔镜胸膜活检在诊断胸腔穿刺结果不明确的胸腔积液方面均具有较高的总体诊断率（>80%），但统计学上无显著差异。两种方法在诊断结核性胸膜炎方面均具有较高的敏感性（>80%），但统计学上无显著差异。
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