Boutin C, Rey F
Department of Pneumology, Aix-Marseille University Medical School, France.
Cancer. 1993 Jul 15;72(2):389-93. doi: 10.1002/1097-0142(19930715)72:2<389::aid-cncr2820720213>3.0.co;2-v.
To compare the diagnostic value of thoracoscopic biopsy, fluid cytology, and Abrams needle biopsy, the authors analyzed prospectively the records of 188 patients with malignant pleural mesothelioma examined between 1973 and 1990. Symptoms were pleural effusion in 173 patients, empyema in 1, spontaneous pneumothorax in 1, and radiologic tumor without effusion in 13.
Thoracoscopy was performed using a rigid thoracoscope under local anesthesia with neuroleptanalgesia. A total of 10-20 biopsies were taken from the parietal, diaphragmatic, and visceral pleura. Each diagnosis was confirmed by the French panel of mesothelioma pathologists. To prevent parietal seeding, radiation therapy at a dose of 21 Gy was administered during a period of 3 days to all points of entry.
Tolerance to thoracoscopy was good. The only complications were subcutaneous emphysema (1 patient), local pleural infection (4 patients), hemorrhage of less than 100 ml (3 patients), and temperature of 38-38.5 degrees C (26 patients). In 137 patients, the cavity was free, and complete endoscopic inspection was achieved. In 51 patients, inspection was limited by adhesions that were severed to obtain biopsy. Nonspecific inflammation was observed in 12 patients (6.5%), nodules in 92 (49%), thickening in 21 (11%), and mixed lesions in 63 (33.5%). Diagnosis was achieved by thoracoscopy in 98% of patients, by fluid cytology in 26%, and by needle biopsy in 21%.
In most patients, thoracoscopy allows complete visualization of the pleural cavity and provides high-quality biopsy samples. The diagnostic accuracy of thoracoscopy is similar to open thoracotomy, but the procedure is far less invasive, usually requiring that the patient remain in the hospital only 1 day.
为比较胸腔镜活检、胸水细胞学检查及Abrams针穿刺活检的诊断价值，作者前瞻性分析了1973年至1990年间接受检查的188例恶性胸膜间皮瘤患者的记录。症状包括173例胸腔积液、1例脓胸、1例自发性气胸以及13例无积液的放射性肿瘤。
在局部麻醉复合神经安定镇痛下使用硬式胸腔镜进行胸腔镜检查。从壁层、膈面和脏层胸膜共取10 - 20块活检组织。每项诊断均由法国间皮瘤病理学家小组确认。为防止壁层种植，对所有穿刺点在3天内给予21 Gy的放射治疗。
胸腔镜检查耐受性良好。仅出现皮下气肿（1例患者）、局部胸膜感染（4例患者）、出血量小于100 ml（3例患者）以及体温38 - 38.5摄氏度（26例患者）等并发症。137例患者胸腔无粘连，可进行完整的内镜检查。51例患者因粘连限制检查，需切断粘连以获取活检组织。12例患者（6.5%）观察到非特异性炎症，92例（49%）有结节，21例（11%）有增厚，63例（33.5%）有混合性病变。98%的患者通过胸腔镜检查确诊，26%通过胸水细胞学检查确诊，21%通过针穿刺活检确诊。
在大多数患者中，胸腔镜检查可完整观察胸腔并提供高质量的活检样本。胸腔镜检查的诊断准确性与开胸手术相似，但该操作创伤小得多，患者通常仅需住院1天。
