Kirsch C M, Kroe D M, Azzi R L, Jensen W A, Kagawa F T, Wehner J H
Division of Respiratory and Critical Care Medicine, Santa Clara Valley Medical Center, San Jose, Calif, USA.
Chest. 1997 Sep;112(3):702-6. doi: 10.1378/chest.112.3.702.
To determine the optimal number of pleural biopsy (PLBX) specimens for a diagnosis of tuberculous pleurisy.
Retrospective review.
County hospital.
We reviewed all percutaneous needle biopsy specimens of the parietal pleura in 30 patients who had tuberculous pleurisy. Data are reported as mean+/-SEM and statistical comparisons are done with the Mann-Whitney test. We accepted p<0.05 as statistically significant.
The number of biopsy specimens obtained from each patient ranged from 4 to 10 with 1 sample submitted for mycobacterial culture and the rest submitted for histologic study. Sixty percent of patients had pleural cultures positive for Mycobacterium tuberculosis and 80% had diagnostic histology. Overall pleural biopsy sensitivity (histology and culture) for tuberculous pleurisy was 87%. On average, 40.4%+/-4.7% of all PLBX specimens contained pleura. Diagnostic PLBX procedures compared to false-negative procedures produced more tissue specimens (7.1+/-0.3 vs 4.8+/-0.5, p=0.005) containing more pleural specimens (2.4+/-0.2 vs 0.8+/-0.5, p=0.01). If only PLBX procedures yielding more than six tissue specimens (n=18) or more than two pleural specimens (n=12) were analyzed, then the diagnostic sensitivity of PLBX for pleural tuberculosis was 100%. There seemed to be a direct relationship between the sensitivity of PLBX and the number of specimens submitted.
The sensitivity of percutaneous needle biopsy for diagnosis of tuberculous pleurisy is highest when more than six specimens are obtained which, on average, contain more than two specimens of parietal pleura. There are no conclusive data indicating how many tissue specimens to submit for mycobacterial culture, but one specimen seems sufficient.
确定用于诊断结核性胸膜炎的胸膜 biopsy（经皮胸膜活检（PLBX）标本的最佳数量。
回顾性研究。
县医院。
我们回顾了30例结核性胸膜炎患者的所有经皮壁层胸膜穿刺活检标本。数据以平均值±标准误报告，采用Mann-Whitney检验进行统计学比较。我们将p<0.05视为具有统计学意义。
每位患者获得的活检标本数量为4至10个，1份样本送结核菌培养，其余送组织学检查。60%的患者胸膜培养结核分枝杆菌阳性，80%有诊断性组织学结果。结核性胸膜炎的总体胸膜活检敏感性（组织学和培养）为87%。所有PLBX标本平均40.4%±4.7%含有胸膜组织。与假阴性操作相比，诊断性PLBX操作产生的组织标本更多（7.1±0.3对4.8±0.5，p=0.005），胸膜标本更多（2.4±0.2对0.8±0.5，p=0.01）。如果仅分析获得超过6个组织标本（n=18）或超过2个胸膜标本（n=12）的PLBX操作，则PLBX对胸膜结核的诊断敏感性为100%。PLBX的敏感性与送检标本数量之间似乎存在直接关系。
当获得超过6个标本时，经皮胸膜穿刺活检诊断结核性胸膜炎的敏感性最高，平均而言，这些标本包含超过2个壁层胸膜标本。没有确凿数据表明应送多少组织标本进行结核菌培养，但1份标本似乎就足够了。
