超声引导下胸膜活检与内科胸腔镜活检诊断一致性分析

doi:10.3877/cma.j.issn.1674-6902.2024.02.003

目的

通过回顾性分析超声引导下胸膜活检(ultrasound-guided pleural biopsy, USPB)和内科胸腔镜胸膜活检(medical thoracoscopy pleural biopsy, MTPB)的胸腔积液患者临床资料，分析两种取材方法的选择和诊断一致性。

方法

选择2020年10月至2023年5月由我院呼吸与危重症医学科进行超声引导下胸膜活检和内科胸腔镜胸膜活检的胸腔积液患者74例，对临床资料、胸腔积液特征、取材质量和病理诊断价值进行分析。

结果

先行超声引导下胸膜活检后再行内科胸腔镜胸膜活检患者USPB＋MTPB组40例，取材的病理诊断价值并不优于直接行内科胸腔镜胸膜活检患者MTPB组34例，差异具有统计学意义(P<0.001)。40例USPB＋MTPB组患者中，USPB和MTPB所取标本大小0.004(0.003，0.011)mm³和0.105(0.026，0.230)mm³，差异具有统计学意义(P<0.001)。进一步分析，USPB取材病理诊断价值并不优于MTPB，差异具有统计学意义(P<0.001)。USPB和MTPB的阳性率是65.00%和95.00%；阴性率分别是35.00%和5.00%。USPB和MTPB的可靠性评价指标卡帕值(Kappa value)＝0.038。

结论

MTPB在阳性诊断率、取材质量和病理诊断价值方面优于USPB，临床在二者的选择上应结合患者个体化、安全性及可及性等进行综合考虑。

关键词: 胸腔积液, 超声引导下胸膜活检, 内科胸腔镜胸膜活检

Objective

The clinical data of patients with pleural effusion by ultrasound guided pleural biopsy (USPB) and medical thoracoscopic pleural biopsy (MTPB) were retrospectively analyzed, to explore the selection and diagnostic consistency of these two sampling methods.

Methods

74 patients with pleural effusion by USPB and MTPB were recruited in the Department of Respiratory and Critical Care Medicine of our hospital from October 2020 to May 2023. The general clinical data, pleural effusion characteristics, sample quality, and pathological diagnostic value were analyzed.

Results

The pathological diagnostic value of patients who underwent USPB before undergoing MTPB (USPB+ MTPB group) 40 cases was not superior to those who directly underwent MTPB (MTPB group)34 cases, and the difference was statistically significant (P=0.007). Among the 40 patients in the USPB+ MTPB group, the sample sizes of USPB and MTPB were 0.004 (0.003, 0.011) mm³ and 0.105 (0.026, 0.230) mm^3, with statistically significant differences (P<0.001); the pathological diagnostic value of USPB is not superior to that of MTPB, and the difference is statistically significant (P<0.001). The positive rates of USPB and MTPB were 65.00% and 95.00%, respectively; the negative rates were 35.00% and 5.00%, respectively. The reliability evaluation index Kappa value of USPB and MTPB is 0.038.

Conclusion

MTPB is superior to USPB in terms of positive diagnostic rate, sample quality, and pathological diagnostic value. Clinicians should also consider patient individualization, safety, and accessibility when selecting the two.

Key words: Pleural effusion, Ultrasound guided pleural biopsy, Medical thoracoscopy pleural biopsy

图1 74例胸腔积液患者诊断筛查流程。注：MTPB：内科胸腔镜胸膜活检；USPB：超声引导下胸膜活检；MTPB＋USTB：先行USTB后行MTPB；MTPB-USTB：只行MTPB而未行USTB；病理诊断价值(等级)：A级、B级、C级、D级

表1 40例胸腔积液患者前后行USPB和MTPB所取标本大小及病理结果比较[n(%)]

临床资料	变量	USPB组	MTPB组	检验值	P值
标本大小[V, M(Q₁，Q₃)]	体积(mm³)	0.004(0.003，0.011)	0.105(0.026，0.230)	5.448	0.000
病理诊断价值(等级)	A	0	2(5.00)
	B	3(7.50)	14(35.00)	16.099	0.000
	C	23(57.50)	22(55.00)
	D	14(35.00)	2(5.00)

表1 40例胸腔积液患者前后行USPB和MTPB所取标本大小及病理结果比较[n(%)]

临床资料	变量	USPB组	MTPB组	检验值	P值
标本大小[V, M(Q₁，Q₃)]	体积(mm³)	0.004(0.003，0.011)	0.105(0.026，0.230)	5.448	0.000
病理诊断价值(等级)	A	0	2(5.00)
	B	3(7.50)	14(35.00)	16.099	0.000
	C	23(57.50)	22(55.00)
	D	14(35.00)	2(5.00)

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Analysis of consistency between ultrasound-guided pleural biopsy and medical thoracoscopy pleural biopsy in diagnosis

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Analysis of consistency between ultrasound-guided pleural biopsy and medical thoracoscopy pleural biopsy in diagnosis