Luo Weizhan, Zeng Yunxiang, Shen Panxiao, Wu Xiaobing, Wang Jinlin, Zhang Ximing
Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China.
J Thorac Dis. 2020 Aug;12(8):4338-4346. doi: 10.21037/jtd-20-1119.
There is little detailed information regarding benign asbestos pleural effusion (BAPE). It is frequently misdiagnosed because of lack of a standardized diagnostic approach and criteria. The present study aimed to better characterize BAPE and outline a diagnostic approach for this disease.
Complete clinical data of 11 consecutive patients with BAPE were prospectively collected and analysed. A multidisciplinary team (MDT) was involved in discussing the suspected cases of BAPE. The team was comprised of thoracic physicians, radiologists and pathologists. A multidisciplinary practical diagnostic approach for BAPE was introduced.
Six patients had respiratory symptoms, but another 5 were asymptomatic. All the patients had an asbestos exposure and the median duration was 23.9 years (rang, 12-36 years). The median level of lactate dehydrogenase (LDH), adenosine deaminase (ADA), proteins and carcinoembryonic antigen (CEA) in the pleural fluid (PF) were 221.4 U/L (range, 189.8-11,325 U/L), 21 U/L (rang, 14-247 U/L), 48.3 g/dL (range, 35.2-53.2 g/dL) and 3.46 mg/mL (range, 0.84-4.54 mg/mL), respectively. Five patients had pleural plaques, 2 had diffuse pleural thickening (DPT), 1 had asbestosis, and 1 had round atelectasis. The pleural biopsy specimens showed a benign fibrotic pleura in all case. The symptoms and pleural pulmonary radiologic findings remained stable during the follow-up.
BAPE is diagnosed by exclusion. A suspected diagnosis of BAPE with an asbestos exposure should be considered, especially with the presence of pleural plaques, and/or DPT, and rounded atelectasis. The MDT-based diagnostic approach may reduce misdiagnosis.
关于良性石棉性胸腔积液（BAPE）的详细信息较少。由于缺乏标准化的诊断方法和标准，该病常被误诊。本研究旨在更好地描述BAPE的特征，并概述针对该疾病的诊断方法。
前瞻性收集并分析了11例连续的BAPE患者的完整临床数据。一个多学科团队（MDT）参与讨论BAPE疑似病例。该团队由胸科医生、放射科医生和病理科医生组成。引入了一种针对BAPE的多学科实用诊断方法。
6例患者有呼吸道症状，但另外5例无症状。所有患者均有石棉接触史，中位接触时长为23.9年（范围为12 - 36年）。胸腔积液（PF）中乳酸脱氢酶（LDH）、腺苷脱氨酶（ADA）、蛋白质和癌胚抗原（CEA）的中位水平分别为221.4 U/L（范围为189.8 - 11325 U/L）、21 U/L（范围为14 - 247 U/L）、48.3 g/dL（范围为35.2 - 53.2 g/dL）和3.46 mg/mL（范围为0.84 - 4.54 mg/mL）。5例患者有胸膜斑，2例有弥漫性胸膜增厚（DPT），1例有石棉肺，1例有圆形肺不张。所有病例的胸膜活检标本均显示为良性纤维化胸膜。随访期间症状和胸膜肺部影像学表现保持稳定。
BAPE通过排除法诊断。对于有石棉接触史的患者，尤其是存在胸膜斑、和/或DPT以及圆形肺不张时，应考虑BAPE的疑似诊断。基于MDT的诊断方法可能减少误诊。
