Department of Respiratory Medicine, University of Occupational and Environmental Health Japan, Kitakyushu City, Japan.
Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health Japan, Kitakyushu City, Japan.
Thorac Cancer. 2022 Apr;13(8):1136-1142. doi: 10.1111/1759-7714.14368. Epub 2022 Mar 4.
Pleural biopsies for investigating the causes of pleurisy are performed through modalities including needle biopsies, local anesthetic thoracoscopic procedures, and surgery (video-assisted thoracoscopic surgery and open thoracotomy). To date, there have been no large-scale nationwide epidemiological studies regarding pleurisy diagnosed via surgical pleural biopsy. This study examined the epidemiology of pleurisy diagnosed via surgical pleural biopsy in a Japanese nationwide administrative database.
We evaluated Japanese Diagnosis Procedure Combination data of 24 173 patients who underwent video-assisted thoracoscopic surgery or open thoracotomy and received a diagnosis of pleurisy between April 2014 and March 2020. In addition to pleurisy diagnoses, the patients' clinical information, including age, sex, smoking status (pack-years), dyspnea grade, length of in-hospital stay, and comorbidities, were extracted from the dataset.
This study included data from 1699 patients. The most frequent causes of pleurisy were neoplastic diseases (55.9%; malignant mesothelioma 22.5%, lung cancer 15.7%, lymphoma 2.5%), followed by infectious diseases (24.0%; tuberculosis 16.2%, parapneumonic pleural effusion 3.6%, empyema 3.5%, nontuberculous mycobacteriosis 0.5%), collagen vascular diseases (2.8%; rheumatoid arthritis 1.3%, immunoglobulin G4-related diseases 0.7%, systemic lupus erythematosus 0.3%), and paragonimiasis (0.1%).
Neoplastic diseases, including malignant mesothelioma and lung cancer, were frequently and accurately diagnosed as pleurisy via surgical pleural biopsy. The next leading cause was infectious diseases such as mycobacterial infections. Physicians should consider performing surgical biopsy in light of the knowledge regarding the etiology of pleurisy when a definitive diagnosis cannot be made via needle pleural biopsy.
胸膜活检术可用于诊断胸膜炎，包括经皮针活检、局部麻醉下的电视辅助胸腔镜检查和手术（电视辅助胸腔镜手术和开胸手术）。迄今为止，尚无关于通过手术性胸膜活检诊断的胸膜炎的大规模全国性流行病学研究。本研究通过日本全国行政数据库研究了通过手术性胸膜活检诊断的胸膜炎的流行病学。
我们评估了 2014 年 4 月至 2020 年 3 月期间接受电视辅助胸腔镜手术或开胸手术并诊断为胸膜炎的 24173 例患者的日本诊断程序组合数据。除胸膜疾病诊断外，还从数据集提取了患者的临床信息，包括年龄、性别、吸烟状况（包年）、呼吸困难分级、住院时间和合并症。
本研究纳入了 1699 例患者的数据。胸膜炎最常见的病因是肿瘤性疾病（55.9%；恶性间皮瘤 22.5%、肺癌 15.7%、淋巴瘤 2.5%），其次是感染性疾病（24.0%；结核性胸膜炎 16.2%、类肺炎性胸腔积液 3.6%、脓胸 3.5%、非结核分枝杆菌病 0.5%）、胶原血管疾病（2.8%；类风湿关节炎 1.3%、IgG4 相关疾病 0.7%、系统性红斑狼疮 0.3%）和并殖吸虫病（0.1%）。
包括恶性间皮瘤和肺癌在内的肿瘤性疾病常通过手术性胸膜活检准确诊断为胸膜炎。其次是分枝杆菌感染等感染性疾病。当无法通过经皮胸膜活检获得明确诊断时，医生应根据胸膜炎病因的相关知识考虑进行外科活检。
