Brun Clement, Gay Pierre, Cottier Michele, Karpathiou Georgia, Patoir Arnaud, Tiffet Oliviet, Barral Fabrice-Guy, Vergnon Jean-Michel, Froudarakis Marios E
Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France.
Departments of Cytology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France.
J Thorac Dis. 2018 Dec;10(12):6903-6911. doi: 10.21037/jtd.2018.11.127.
Malignant pleural effusion (MPE) is a common medical problem in lung cancer (LC). Pleural fluid cytology (PFC), chest computed tomography (CCT) and positron emission tomography (PET) findings are helpful as first line approach. The objectives of this study were to evaluate whether there is a correlation between PFC, CCT and PET in patients with MPE due to LC.
We selected patients from our electronic files. Data of PFC, pleural biopsy (PB), CCT and PET have been recorded and analyzed.
A total of 101 consecutive patients (66 males, 65.3%) with a mean age of 66.2±31 years were selected. Types of LC were adenocarcinoma in 71 patients (70.2%), squamous in 13 (12.8%), small-cell in 12 (11.8%) and large cell in 5 (4.9%). CCT showed nodules in 6 (5.9%), pleural thickening in 8 (7.9%) and both in 17 (16.8%) patients. PFC was positive in 55/91 thoracentesis (60.4%) and 32/52 thoracoscopy (61.5%), while PB in 38/40 performed (95%). PET fixation was found in 32/47 (68%) patients who had MPE at diagnosis. When we associate PFC to CCT and PET findings, the yield in our study becomes 90%. No correlation was observed between CCT findings and PFC (P=0.62) between PFC and PET fixation (P=0.63) or between CCT and PET (P=0.06).
In our cohort of LC patients with MPE, we observed a high sensitivity for PFC, while in most of the cases no findings were observed in CCT. PET had a relative low sensitivity. However, when all 3 methods were combined the yield was 90%.
恶性胸腔积液（MPE）是肺癌（LC）常见的医学问题。胸水细胞学检查（PFC）、胸部计算机断层扫描（CCT）和正电子发射断层扫描（PET）结果有助于作为一线检查方法。本研究的目的是评估因肺癌导致的恶性胸腔积液患者的胸水细胞学检查、胸部计算机断层扫描和正电子发射断层扫描之间是否存在相关性。
我们从电子病历中选取患者。记录并分析了胸水细胞学检查、胸膜活检（PB）、胸部计算机断层扫描和正电子发射断层扫描的数据。
共选取了101例连续患者（66例男性，占65.3%），平均年龄为66.2±31岁。肺癌类型为腺癌71例（70.2%），鳞癌13例（12.8%），小细胞癌12例（11.8%），大细胞癌5例（4.9%）。胸部计算机断层扫描显示6例（5.9%）有结节，8例（7.9%）有胸膜增厚，17例（16.8%）两者皆有。胸水细胞学检查在91例胸腔穿刺术中55例阳性（60.4%），在52例胸腔镜检查中32例阳性（61.5%），而胸膜活检在40例检查中38例阳性（95%）。在诊断时患有恶性胸腔积液的47例患者中，32例（68%）发现有PET固定。当我们将胸水细胞学检查结果与胸部计算机断层扫描和正电子发射断层扫描结果相关联时，本研究中的检出率为90%。未观察到胸部计算机断层扫描结果与胸水细胞学检查之间存在相关性（P=0.62），胸水细胞学检查与PET固定之间存在相关性（P=0.63），或胸部计算机断层扫描与PET之间存在相关性（P=0.06）。
在我们这组患有恶性胸腔积液的肺癌患者中，我们观察到胸水细胞学检查具有较高的敏感性，而在大多数病例中胸部计算机断层扫描未发现异常。PET的敏感性相对较低。然而，当将这三种方法结合使用时，检出率为90%。
