Department of Respiratory Medicine, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK.
Department of Respiratory Medicine, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK.
Respir Med. 2022 Aug;199:106883. doi: 10.1016/j.rmed.2022.106883. Epub 2022 May 19.
Medical thoracoscopy (MT) is a well-established diagnostic procedure in cases of unexplained exudative pleural effusions. Despite the advantages of MT, challenges remain since occasionally malignancies mimic pleural inflammation.
To assess the relationship between the macroscopic appearance of the pleura at MT, the histology of the pleural biopsy and the final diagnosis after follow up.
Data was prospectively collected on patients undergoing MT over 8 years, using a standardised electronic thoracoscopy report. We report the sensitivity, specificity, positive and negative predictive values (PPV, NPV) of the macroscopic changes, the sensitivity of computer tomographic (CT) appearances and final outcome.
A total of 228 thoracoscopies and biopsy were performed, 70 reports described benign macroscopic changes; of these 15.7% had malignant histology. When the final outcome was taken into account, the sensitivity of macroscopic appearance at MT was 91.5%, specificity 76.0%, PPV 88.6% and the NPV 81.4%. Nodular changes were more likely to be associated with malignancy (Chi 75.5, p < 0.05). The CT scans performed prior to thoracoscopy had a poor sensitivity for the diagnosis of malignant pleural effusion (50%) and a good specificity in the diagnosis of benign disease (90.5%).
A standardised structured report allows reliable evaluation of the macroscopic findings at MT. The PPV of the macroscopic findings for malignancy is relatively high; however, in a significant minority of cases despite benign-looking macroscopic changes the final diagnosis was malignancy. Careful consideration must be given in cases with benign histology to either monitoring or further diagnostic tests based on clinical suspicion.
在不明渗出性胸腔积液的情况下，医学胸腔镜（MT）是一种成熟的诊断程序。尽管 MT 具有优势，但仍存在挑战，因为偶尔恶性肿瘤会模仿胸膜炎症。
评估 MT 时胸膜的大体外观、胸膜活检的组织学和随访后的最终诊断之间的关系。
使用标准化电子胸腔镜报告，前瞻性收集 8 年来接受 MT 的患者的数据。我们报告了大体变化的敏感性、特异性、阳性和阴性预测值（PPV、NPV）、计算机断层扫描（CT）表现的敏感性和最终结果。
共进行了 228 次胸腔镜检查和活检，70 份报告描述了良性大体变化；其中 15.7%的组织学为恶性。当考虑最终结果时，MT 时大体外观的敏感性为 91.5%，特异性为 76.0%，PPV 为 88.6%，NPV 为 81.4%。结节性改变更可能与恶性肿瘤有关（Chi 75.5，p<0.05）。在 MT 之前进行的 CT 扫描对恶性胸腔积液的诊断敏感性较差（50%），对良性疾病的诊断特异性较高（90.5%）。
标准化的结构化报告允许对 MT 时的大体发现进行可靠评估。恶性肿瘤大体发现的 PPV 相对较高；然而，在相当一部分情况下，尽管大体外观呈良性，但最终诊断仍为恶性肿瘤。对于组织学为良性的病例，必须仔细考虑基于临床怀疑进行监测或进一步的诊断测试。
