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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2021, Vol. 14 ›› Issue (02) : 135 -140. doi: 10.3877/cma.j.issn.1674-6902.2021.02.001

论著

内科胸腔镜联合快速现场评估对不明原因胸腔积液的诊断价值
陈众众1, 刘家昌2, 徐兴祥3, 闵凌峰3,†()   
  1. 1. 232001　淮南，安徽理工大学第一附属医院（淮南市第一人民医院）呼吸与危重症医学科；225001　江苏，扬州大连医科大学附属苏北医院　扬州大学医学院附属苏北人民医院呼吸与危重症医学科
    2. 232001　淮南，安徽理工大学第一附属医院（淮南市第一人民医院）呼吸与危重症医学科
    3. 225001　江苏，扬州大连医科大学附属苏北医院　扬州大学医学院附属苏北人民医院呼吸与危重症医学科
  • 收稿日期:2020-11-25 出版日期:2021-04-25
  • 通信作者: 闵凌峰
  • 基金资助:
    国家自然科学基金资助项目(81870033)

Diagnosis value of medical thoracoscopy combine with rapid on-site evaluation in undiagnosed pleural effusion

Zhongzhong Chen1, Jiachang Liu2, Xingxiang Xu3, Lingfeng Min3,†()   

  1. 1. Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Anhui University of Science and Technongy (Huainan First People′s Hospital), Huainan, 232001, China; Department of Respiratory and Critical Care Medicine of North Jiangsu Hospital Affiliated to Dalian Medical University, North Jiangsu People′s Hospital Affiliated to Yangzhou University Medical College, Yangzhou, 225001, China
    2. Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Anhui University of Science and Technongy (Huainan First People′s Hospital), Huainan, 232001, China
    3. Department of Respiratory and Critical Care Medicine of North Jiangsu Hospital Affiliated to Dalian Medical University, North Jiangsu People′s Hospital Affiliated to Yangzhou University Medical College, Yangzhou, 225001, China
  • Received:2020-11-25 Published:2021-04-25
  • Corresponding author: Lingfeng Min
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陈众众, 刘家昌, 徐兴祥, 闵凌峰. 内科胸腔镜联合快速现场评估对不明原因胸腔积液的诊断价值[J]. 中华肺部疾病杂志(电子版), 2021, 14(02): 135-140.

Zhongzhong Chen, Jiachang Liu, Xingxiang Xu, Lingfeng Min. Diagnosis value of medical thoracoscopy combine with rapid on-site evaluation in undiagnosed pleural effusion[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2021, 14(02): 135-140.

目的

探讨内科胸腔镜联合快速现场评估(ROSE)对不明原因胸腔积液的诊断价值及临床应用。

方法

回顾性分析98例不明原因胸腔积液患者的临床资料，其中内科胸腔镜联合ROSE检查的患者52例，未联合ROSE检查的患者46例。比较两组患者胸膜活检情况、二次检查率、并发症发生率、诊断率，分析ROSE结果与术后病理一致性及ROSE对良、恶性胸腔积液的诊断价值。

结果

ROSE组活检次数、活检时间均明显低于未联合组，差异均有统计学意义(P<0.05)，而ROSE组出血发生率、并发症发生率、二次检查率均低于未联合组，无明显统计差异(P>0.05)。ROSE结果与术后病理结果具有较高的一致性(Kappa＝0.699，P<0.001)。ROSE组总体诊断率为92.30%，未联合组总体诊断率为89.13%。ROSE对恶性疾病的诊断敏感性为79.3%，特异性为95.7%，准确性为86.5%，阳性预测值为95.9%，阴性预测值为78.6%。而ROSE对良性疾病的诊断敏感性、特异性、准确性分别为91.3%、93.1%、92.3%，阳性预测值为91.3%，阴性预测值为93.1%。

结论

内科胸腔镜联合ROSE对不明原因胸腔积液的诊断具有较高的诊断价值，ROSE应用于内科胸腔镜现场活检取材有助于提高取材成功率，减少无效取材，安全性较高，有较高的临床应用价值，值得临床尝试。

关键词: 内科胸腔镜, 快速现场评估, 不明原因胸腔积液, 诊断价值
Objective

To explore the diagnostic value of thoracoscopy combined with rapid on-site evaluation (ROSE) in the treatment of unexplained pleural effusion and the clinical application value of ROSE.

Methods

A total of 98 patients were selected for retrospective analysis in this study, including 52 patients who underwent thoracoscopic combined ROSE examination and 46 patients who did not undergo ROSE examination. The frequency of pleural biopsy, biopsy time, secondary inspection rate, complications and diagnosis rate of the two groups were compared, the consistency between ROSE results and postoperative pathology was analyzed, and the diagnostic value of ROSE for unknown pleural effusion was evaluated.

Result

The number and time of biopsy in the ROSE group were significantly lower than those in the non-ROSE groups, with statistically significant differences (P<0.05), while the bleeding rate, complication rate and secondary examination rate in the ROSE group were all lower than those in the non-ROSE groups, but there was no statistical difference between the two groups (P>0.05). ROSE has good concordance with routine pathological examination in the diagnosis of unidentified pleural effusion (Kappa value was 0.699, P<0.001). The diagnostic accuracy rate of ROSE for unidentified pleural effusion was 92.30%, non-ROSE groups was 89.13%. The sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value of ROSE in the diagnosis of malignancy was 79.3%, 95.7%, 86.5%, 95.9% and 78.6% respectively. The sensitivity, specificity, diagnostic accuracy value of ROSE in the diagnosis of benign lesions was 91.3%, 93.1% and 92.3%, with positive predictive value of 91.3% and negative predictive value of 93.1%.

Conclusion

Medical thoracoscopy combined with ROSE has a high diagnostic value in the unexplained pleural effusion, medical thoracoscopy combined with ROSE for field guidance can improve the success rate of sampling, reduce procedure times and biopsy time without increasing the risk of bleeding. And ROSE has a high clinical value in the application of medical thoracoscopy, which is worthy of clinical promotion and application.

Key words: Medical thoracoscopy, Rapid on-site evaluation, Undiagnosed pleural effusion, Diagnostic value
表1 两组诊疗指标比较[n(%)]
组　别 例数 活检次数(次) 活检时间(min) 出血发生 二次检查
ROSE组 52 4.98±1.51 17.56±4.57 2(3.85) 1(1.92)
未联合组 46 6.07±1.34 21.04±6.18 4(8.70) 3(6.52)
P值   0.001 0.002 0.415 0.339
表2 ROSE结果与术后病理一致性(n)
ROSE 术后常规病理结果 合计 Kappa值 P值
恶性细胞 炎性细胞 可疑癌细胞
恶性细胞 22 0 2 24    
炎性细胞 2 20 1 23 0.699 0.000
可疑癌细胞 3 1 1 5    
合　计 27 21 4 52    
图1 ROSE对诊断恶性胸腔积液的ROC曲线
图2 ROSE对诊断良性胸腔积液的ROC曲线
1
Chang CY. Peripheral T-cell lymphoma presenting with pleural effusion[J]. QJM, 2021, 114(1): 55.
2
Mishra AK, Verma SK, Kant S, et al. A study to compare the diagnostic efficacy of closed pleural biopsy with that of the thoracoscopic guided pleural biopsy in patients of pleural effusion[J]. South Asian J Cancer, 2016, 5(1): 27-28.
3
王凯歌，李为民，田攀文，等. 内科胸腔镜下胸膜活检术的应用进展[J]. 中华结核和呼吸杂志，2020, 43(7): 592-594.
4
Bansal S, Saurabh M, Pavan T, et al. Rigid mini-thoracoscopy versus semirigid thoracoscopy in undiagnosed exudative pleural effusion: the MINT randomized controlled trial[J]. J Bronchol Int Pulmonol, 2020, 27(3): 163-167.
5
Sourabh P, Madan K, Mohan A, et al. Medical Thoracoscopy for Pleural Infection: Are We There Yet？[J]. Ann Am Thorac Soc, 2020: PMID: 32667210
6
Marwah V, Bhattacharyya D, Mohamed A, et al. Diagnostic utility of medical thoracoscopy in undiagnosed exudative pleural effusions[J]. Med J Dr. D．Y. Patil Vidyapeeth, 2020, 13(5): 1-3.
7
Shrestha BK, Adhikari S, Thakur BK, et al. Medical thoracoscopy for undiagnosed exudative pleural effusion: experience from two tertiary care hospitals of nepal[J]. JNMA J Nepal Med Assoc, 2020, 58(223): 158-164.
8
宋　玲. 内科胸腔镜在不明原因胸腔积液中的诊断价值分析[J]. 医学理论与实践，2019, 32(4): 575-577.
9
Baas P, Martijn T, Sjaak B, et al. Fluorescence detection of pleural malignancies using 5-aminolaevulinic acid[J]. Chest, 2006, 129(3): 718-724.
10
Ling G, Huang G, Huang Y, et al. Medical Thoracoscopy for the Management of Exudative Pleural Effusion: A Retrospective Study.[J]. Risk Manag Healthcare Policy, 2020, 13: 2845-2855.
11
刘志学. 内镜介入在呼吸疾病诊疗领域应用前景无限——访首都医科大学附属北京胸科医院内镜诊疗中心主任丁卫民教授[J]. 中国医药导报，2019, 16(12): 1-3.
12
王忠弢，石永生. 快速现场评价在现代儿科介入呼吸病学的应用[J]. 中国实用儿科杂志，2019, 34(6): 470-475.
13
陈伟庄，王　辉，李　优，等. 快速现场评价在超声气管镜针吸活检诊断纵膈病灶中的应用[J]. 中国内镜杂志，2021, 27(3): 1-9.
14
黄玉胜，夏　蕾，唐翠萍，等. 快速现场评估在CT引导下经皮肺穿刺活检中的应用研究[J]. 重庆医学，2020, 49: 1-4.
15
Khan KA, Narine N, Bailey S, et al. Rapid on-site evaluation (ROSE) defines optimal EBUS sampling and its impact on rapid treatment decision making[J]. Lung Cancer, 2020, 139(S1): DOI: 10.1016/S0169-5002(20)30059-3
16
Peng TF, Ren T, Wang HS, et al. Diagnostic value of rapid on-site evaluation for CT-guided percutaneous fine needle aspiration in the diagnosis of pulmonary occupying lesions.[J]. BioMed Res Int, 2020, 2020: DOI: 10.1155/2020/9842768
17
李燕燕，李凯述，王　洵，等. 快速现场细胞学在CT引导下经皮穿刺活检肺外周结节中的应用[J]. 中国介入影像与治疗学，2020, 17(1): 18-21.
18
张　梁，嵇小平，徐光辉. 电子气管镜联合快速现场评估对肺部肿瘤的诊断价值[J]. 当代医学，2020, 26(34): 109-111.
19
张　磊，叶联华，陈　颖，等. 现场快速评估在经超声支气管镜针吸活检中的应用评价[J]. 中国当代医药，2017, 24(24): 7-10.
20
魏学强，万良红，张志斌，等. Lung-pro联合快速现场评估在周围型肺结节诊断中的作用[J]. 昆明医科大学学报，2020, 41(5): 80-84.
21
李　真，孟　婕，胡成平，等. 412例胸膜疾病胸腔镜下的表现与诊断分析[J]. 中国内镜杂志，2015, 21(9): 897-900.
22
王丽芳. 内科胸腔镜对53例不明原因胸腔积液的临床应用价值[J]. 中国医药科学，2020, 10(15): 237-239.
23
郑巍亮，余江清，卢志军，等. 内科胸腔镜在胸腔积液的临床价值[J]. 当代医学，2020, 26(20): 145-147.
24
黄永平，李梦洁，所元东，等. 远程细胞病理学在快速现场评估细针穿刺活检中的临床研究进展[J]. 重庆医学，2021, 50(1): 1-10.
25
李文君，陶红艳，石　磊，等. 现场现时快速评判应用于超声内镜引导下的经支气管针吸活检对肺癌诊断价值的研究进展[J]. 中国医学科学院学报，2020, 42(6): 820-824.
26
Xu Chunhua, Wang Yan, Wang Wei, et al. Improved diagnostic yield of transbronchial lung biopsy in peripheral pulmonary lesions using a combination of endobronchial ultrasound and rapid on-site evaluation[J]. J Int Med Res, 2021, 49(3): 300060521999535.
27
张　炜，王玉梅，陈　茗，等. 经支气管镜肺活检术及经皮穿刺肺活检术联合快速现场细胞学评价在肺部阴影诊断中的价值[J]. 标记免疫分析与临床，2020, 27(10): 1719-1722.
28
Diogo TH, Thomas RMcCarty, Pichamol J, et al. EUS-guided fine-needle biopsy sampling versus FNA in the diagnosis of subepithelial lesions: a large multicenter study[J]. Gastrointestinal Endoscopy, 2020, 92(1): 108-119.
29
Weng Xw, Zhi Lj, An X, et al. Diagnostic value of rapid on-site evaluation in interventional pulmonology: A protocol for systematic review and meta analysis[J]. Medicine, 2020, 99(29): e21168.
30
Santos RSD, Jacomelli M, Franceschini JP, et al. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in diagnosis of mediastinal lesions.[J]. Einstein (Sao Paulo, Brazil), 2018, 16(2): PMID: 29768518
31
向　青，万　涛，胡前方，等. 快速现场细胞学评价在EBUS-TBNA取样诊断肺癌中的价值[J]. 中国肺癌杂志，2018, 21(11): 833-840.
32
Maribel-Botana Rial, Rodríguez Irene-Lojo, Roibás Cecilia-Mouronte，et al. Diagnostic yield and safety of pleural cryobiopsy during medical thoracoscopy to diagnose pleural effusion. A systematic review and meta-analysis[J]. Archivos de Bronconeumología (English Edition), 2020, 56(12): 784-791.
33
Shaikh Faisal, Lentz Robert J, Feller-Kopman David, et al. Medical thoracoscopy in the diagnosis of pleural disease: a guide for the clinician[J]. Expert Rev Respir Med, 2020, 14(10): 987-1000.
34
Wang Zhen, Xu Li-Li, Wu Yan-Bing, et al. Diagnostic value and safety of medical thoracoscopy in tuberculous pleural effusion[J]. Respiratory Medicine, 2015, 109(9): 1188-1192.
35
Li Cl, Xie W, Cao J, et al. Detailed procedure and clinical application overview of rapid on-site evaluation in diagnostic interventional pulmonology[J]. J Res Med Sci, 2020, 25: 35.
36
李　燕，蔡后荣，演　欣，等. 快速现场评价技术在肺占位病变良恶性判断中的作用[J]. 中国呼吸与危重监护杂志，2018, 17(5): 484-487.
37
Porfyridis I, Georgios G, Michalis M, et al. Rapid on-site evaluation with the Hemacolor rapid staining method of medical thoracoscopy biopsy specimens for the management of pleural disease.[J]. Respirol, 2016, 21(6): 1106-1112.
38
Grosu HB, Macarena VR, Erik V, et al. Pleural touch preparations and direct visualization of the pleura during medical thoracoscopy for the diagnosis of malignancy.[J]. Ann Am Thorac Soc, 2017, 14(8)：1326-1331.
39
Cardoso AV, Neves I, Magalh EA, et al. The value of rapid on-site evaluation during EBUS-TBNA.[J]. Revista Portuguesa de Pneumologia, 2015, 21(5): PMID: 25926258.
40
Liu QH, Arias S, Wang KP. International association for the study of lung cancer map, Wang lymph node map and rapid on-site evaluation in transbronchial needle aspiration[J]. J Thoracic Dis, 2016, 8(9): E869-E874.
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