Zhang Jie, Li Shuhua, Yang Jun, Liu Xiaoping
Department of Respiratory and Critical Care Medicine, The Second People's Hospital of Gansu Province No. 1 Hezheng West Street, Chengguan District, Lanzhou 730000, Gansu, China.
Am J Transl Res. 2025 Jul 15;17(7):5284-5292. doi: 10.62347/SMOO1918. eCollection 2025.
To evaluate the diagnostic accuracy of flexible thoracoscopy in distinguishing between tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE), and to provide clinicians with a reliable method for accurate diagnosis and a basis for appropriate treatment.
This retrospective study was conducted at the Second People's Hospital of Gansu Province from April 2021 to June 2023. A total of 161 patients with confirmed pleural effusion were included. All patients underwent flexible thoracoscopy using the Olympus LTF-240 electronic thoracoscope. Histopathologic findings were used as the diagnostic gold standard.
Under flexible thoracoscopy, pleural features of TPE commonly included hyperemia, edema, fibrous adhesions, and miliary nodules. In contrast, MPE was characterized by multiple nodules, masses, leukoplakia-like changes, and pleural thickening. The areas under the curve for diagnosing TPE and MPE using flexible thoracoscopy were 0.895 and 0.883, respectively. Diagnostic performance was superior in patients with bloody pleural effusion compared to those without. There was no significant difference in the overall complication rates between the TPE and MPE groups (P>0.05). Additionally, in TPE patients, lactate dehydrogenase, adenosine deaminase, and tumor markers were not significantly correlated (both P>0.05), whereas in MPE patients, a negative correlation was observed (P<0.05).
Flexible thoracoscopy demonstrated high diagnostic accuracy in differentiating TPE from MPE and was associated with good safety and patient tolerance, making it a valuable diagnostic tool in clinical practice.
评估可弯曲胸腔镜在鉴别结核性胸腔积液（TPE）和恶性胸腔积液（MPE）方面的诊断准确性，为临床医生提供准确诊断的可靠方法及合理治疗的依据。
本回顾性研究于2021年4月至2023年6月在甘肃省第二人民医院进行。共纳入161例确诊胸腔积液患者。所有患者均使用奥林巴斯LTF - 240电子胸腔镜进行可弯曲胸腔镜检查。组织病理学结果用作诊断金标准。
在可弯曲胸腔镜下，TPE的胸膜特征通常包括充血、水肿、纤维粘连和粟粒结节。相比之下，MPE的特征为多个结节、肿块、白斑样改变和胸膜增厚。使用可弯曲胸腔镜诊断TPE和MPE的曲线下面积分别为0.895和0.883。血性胸腔积液患者的诊断性能优于非血性胸腔积液患者。TPE组和MPE组的总体并发症发生率无显著差异（P>0.05）。此外，在TPE患者中，乳酸脱氢酶、腺苷脱氨酶和肿瘤标志物无显著相关性（均P>0.05），而在MPE患者中观察到负相关（P<0.05）。
可弯曲胸腔镜在鉴别TPE和MPE方面显示出较高的诊断准确性，且安全性良好，患者耐受性佳，使其成为临床实践中有价值的诊断工具。
