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

doi:10.3877/cma.j.issn.1674-6902.2021.02.001

Abstract

Abstract:

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

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.

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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

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

ROSE	术后常规病理结果			合计	Kappa值	P值
ROSE	恶性细胞	炎性细胞	可疑癌细胞	合计	Kappa值	P值
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

ROSE	术后常规病理结果			合计	Kappa值	P值
ROSE	恶性细胞	炎性细胞	可疑癌细胞	合计	Kappa值	P值
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

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