透视引导经胸胸膜活检钳在渗出性胸腔积液患者中的应用。

Fluoroscopy-Guided Percutaneous Transthoracic Pleural Forceps Biopsy in Patients With Exudative Pleural Effusion.

机构信息

Department of Radiology, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Republic of Korea.

Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.

出版信息

Korean J Radiol. 2024 Aug;25(8):706-714. doi: 10.3348/kjr.2023.0960. Epub 2024 Jul 15.

DOI:10.3348/kjr.2023.0960

PMID:39028012

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11306004/

Abstract

OBJECTIVE

This study aimed to evaluate the diagnostic performance and procedural characteristics of fluoroscopy-guided percutaneous transthoracic pleural forceps biopsy (PTPFB) in patients with exudative pleural effusion.

MATERIALS AND METHODS

Patients with exudative pleural effusion who underwent PTPFB between May 1, 2014, and February 28, 2023, were included in this retrospective study. The interval between percutaneous catheter drainage (PCD) and PTPFB, number of biopsies, procedural time, and procedure-related complications were evaluated. The sensitivity, specificity, and accuracy of diagnosing malignancy were computed for pleural cytology using PCD drainage, PTPFB, and combined PTPFB and pleural cytology.

RESULTS

Seventy-one patients, comprising 50 male and 21 female (mean age, 69.5 ± 15.3 years), were included in this study. The final diagnoses were benign lesions in 48 patients (67.6%) and malignant in 23 patients (32.4%). The overall interval between PCD and biopsy was 2.4 ± 3.7 days. The interval between PCD and biopsy in the group that underwent delayed PTPFB was 5.2 ± 3.9 days. The mean number of biopsies was 4.5 ± 1.3. The mean procedural time was 4.4 ± 2.1 minutes. Minor bleeding complications were reported in one patient (1.4%). The sensitivity, specificity, and accuracy for pleural cytology, PTPFB, and combined PTPFB and pleural cytology were 47.8% (11/23), 100% (48/48), and 83.1% (59/71), respectively; 65.2% (15/23), 100% (48/48), and 88.7% (63/71), respectively; and 78.3% (18/23), 100% (48/48), and 93.0% (66/71), respectively. The sensitivity and accuracy of cytology combined with PTPFB were significantly higher than those of cytological testing alone ( = 0.008 and 0.001, respectively).

CONCLUSION

Fluoroscopy-guided PTPFB is an accurate and safe diagnostic technique for patients with exudative pleural effusion, with acceptable diagnostic performance, low complication rates, and reasonable procedural times.

摘要

目的

本研究旨在评估透视引导经皮胸腔穿刺活检（PTPFB）在渗出性胸腔积液患者中的诊断性能和操作特点。

材料和方法

本回顾性研究纳入了 2014 年 5 月 1 日至 2023 年 2 月 28 日期间接受 PTPFB 的渗出性胸腔积液患者。评估了经皮导管引流（PCD）与 PTPFB 之间的时间间隔、活检次数、操作时间和与操作相关的并发症。计算了胸腔积液细胞学检查、PTPFB 和 PTPFB 联合胸腔积液细胞学检查诊断恶性肿瘤的敏感性、特异性和准确性。

结果

本研究纳入了 71 名患者，其中 50 名男性和 21 名女性（平均年龄 69.5±15.3 岁）。最终诊断为良性病变 48 例（67.6%），恶性病变 23 例（32.4%）。PCD 与活检的总间隔时间为 2.4±3.7 天。行延迟 PTPFB 的患者组 PCD 与活检的间隔时间为 5.2±3.9 天。平均活检次数为 4.5±1.3 次。平均操作时间为 4.4±2.1 分钟。1 例（1.4%）患者报告有轻微出血并发症。胸腔积液细胞学检查、PTPFB 和 PTPFB 联合胸腔积液细胞学检查的敏感性、特异性和准确性分别为 47.8%（11/23）、100%（48/48）和 83.1%（59/71）；65.2%（15/23）、100%（48/48）和 88.7%（63/71）；78.3%（18/23）、100%（48/48）和 93.0%（66/71）。细胞学检查联合 PTPFB 的敏感性和准确性明显高于单纯细胞学检查（ = 0.008 和 0.001）。