| Objective: To explore the identifying characteristics of malignant pleural effusion(MPE),establish a clinical diagnostic scoring system for MPE,and evaluate the accuracy of differentiating benign and malignant pleural effusion.Methods: Patients admitted to the central hospital of Dalian from January 1,2012 to December 31,2018 with complete clinical data and diagnosis including pleural effusion who received diagnostic pleural puncture examination during hospitalization were included.According to the diagnostic criteria of pleural effusion,the patients were divided into MPE group and benign pleural effusion(BPE)group.The clinical features,laboratory examinations and chest CT of the included patients were collected for retrospective analysis.A diagnostic model of MPE was established,and a scoring system for clinical diagnosis of MPE was established according to the regression coefficients of various indicators included in the model.The established scoring system was used to differentiate the benign and malignant pleural effusion,and the sensitivity,specificity and accuracy of the diagnosis were evaluated.Results: 1.The Cause distribution of MPE group: lung cancer in 110 cases(76.9%),breast cancer in 8 cases(5.5%),lymphoma in 7 cases(4.8%),malignant pleural mesothelioma in 6 cases(4.1%),gastrointestinal tumor in 6 cases(4.1%),reproductive system tumor in 3 cases(2.0%),Other malignant tumors were found in 3 cases(2.0%),including 1 case of dorsal epithelioid tumor and 2 cases of unknown primary tumor site.The cause distribution of BPE group: parapneumonic effusion in 50 cases(35.2%),tuberculous pleural effusion in 39 cases(27.5%),pyothorax in 10 cases(7.0%),cardiac source in 17 cases(12.0%),kidney source in 4 cases(2.8%),liver source in 3 patients(2.1%),multiple factors combination of 17 cases(12.0%),and 2 cases(1.4%)were caused by other factors,including 1 case of pulmonary embolism and 1 case of acute pancreatitis.2.Characteristics of MPE : Sex,serum carcinoembryonic antigen(sCEA),serum cytokeratin-19-fragment(sCYFRA21-1),serum neuron-specific enolase(s NSE),serum adenosine deaminue(sADA),total cholesterol(TC),pleural effusion carcinoembryonic antigen(pCEA),pCEA/sCEA,pleural effusion lactate dehydrogenase(LDH),pleural effusion/serum LDH,pleural effusion adenosine deaminue(p ADA),neutrophil ratio,abnormal cell number in pleural effusion,the total protein of pleural effusion,property of pleural effusion,color of pleural effusion,Whether are pleural lesions(such as nodules,masses,or pleural thickening)≥1cm,pulmonary masses or nodules ≥1cm,liver metastasis,pleural effusion separation,heart shadow enlargement,unilateral or bilateral pleural effusion,mediastinal lymph node enlargement(P<0.05),the differences between the two groups were statistically significant.3.Establishment of clinical diagnostic model of MPE: gender(P=0.002),pCEA≥4.9ng/ml(P=0.003),s NSE≥13.7ng/ml(P=0.004),p ADA≤24.5U/L(P=0.001),TC≥4.02mmol/L(P=0.006),exuviate pleural effusion(P=0.035),unilateral pleural effusion(P=0.003),complicated pleural lesions(such as nodules,masses or pleural thickening≥1cm)(P=0.043),complicated pulmonary mass Or nodule≥1cm(P=0.005),combined with liver metastasis(P=0.006),pleural effusion without partition(P=0.007),mediastinal lymph node enlargement(P=0.002)finally were included in the MPE clinical diagnostic model.sCEA ≥5.8ng/ml(P=0.496),pCEA/sCEA ≥1.71(P=0.231),sCYFRA21-1 ≥2.79ng/ml(P=0.483),sADA ≤17.5U/L(P=0.889),bloody pleural effluent(P=0.347),and no cardiac enlargement(P=0.580)were excluded from the model.The clinical diagnosis model of MPE established in this study had a good goodness of fit(P=0.993).To judge the prediction effect of the model,the AUC was0.991(95%CI: 0.984-0.998,SE=0.004,P=0.000),indicating that the prediction accuracy of the current model was high.The sensitivity,specificity and accuracy of malignant pleural effusion were 93.70%,95.77% and 94.73%.4.The scoring criteria of the final MPE clinical diagnosis scoring system are as follows: In women(1 point),pCEA≥4.9ng/ml(3 points),s NSE≥13.7ng/ml(1 point),p ADA≤24.5U/L(2 point),TC≥4.02mmol/L(1 point),exuviate pleural effusion(1 point),unilateral pleural effusion(2 points),complicated pleural lesions(such as nodules,masses or pleural thickening≥1cm(1 point),complicated pulmonary masses or nodules≥1cm(2 points),combined with liver metastasis(3 points),pleural effusion without partition(2 points),combined with mediastinal lymph node enlargement(2points).The above diagnostic scoring system was used to score the patients in the two groups respectively,with 14(12,16)points in the MPE group and 7(5,8)points in the BPE group,and the difference between the two groups was statistically significant(Z=-14.197,P= 0.000).ROC curve was plotted based on the scores of the two groups,and the AUC was 0.985(95%CI: 0.975 ～ 0.995,SE: 0.005;P = 0.000).The sensitivity,specificity and accuracy of malignant pleural effusion were 92.31%,94.36% and93.33% when the score was ≥10 points.Conclusions: The clinical diagnosis and scoring system of MPE established in this study has good accuracy,has predictive value for the diagnosis of MPE,and has certain guiding effect for the differentiation of benign and malignant pleural effusion.This scoring model is simple,noninvasive,economical and safe,and has a promising clinical application prospect. |
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