The Clinical Diagnosis Value Of Medical Thoracoscopy Examination Combined With Tumor Marker Determination To Unknown Etiology Pleural Effusion

Objective:To investigate the diagnosis value of Medical thoracoscopy combined detection of CYFRA21-1 and HER-2/neu as tumor markers to the pleural effusion of unknown etiology.Method:Pleural biopsy and pleural effusion samples were collected from 72 patients with various diseases.Of the 72 patients with pleural effusions of unknown etiology,54 were men and 18 were woman(rang 18-65 years).The effusions were considered malignant if maligant cells were found by Medical thoracoscopy biopsy.Only specimens histologically diagnosed as primary malignancies of lung or pleura were considered;malignancies of any other cause were excluded.A total of 72 cases of pleural effusions using Medical thoracoscopy guided to pleural biopsy. The samples after operation were sent to pathology department for living pathological diagnosis.Effusions were collected in sterile tubes and centrifuged immediately at 4℃.Cell-free supematants were collected,and aliquots were stored frozen at -70℃until use.The effusion levels of CYFRA21-1 and HER.2/neu were measured by radioimmuno-assay and enzyme-linked immunosorbent assay respectively.Compared the leveles of CYFRA 21-1 and HER-2 / neu in malignant and benign effusions.Determined the cut-off of this experiment between malignant and benign effusions,calculated and compared the sensitivity,specificity and accuracy of fibrobrouchoscopy in stead of thoracoscopy and the two targetes isolated and Combined.Results:(1)Of the 72 patients with pleural effusion,Malignant cells were found in 70 by Medical thoracoscopy biopsy.The accuracy of them were 97.2%.(2)The leveles of CYFRA 21-1 in malignant effusions were 89.10(58.98-97.09)ng/ml, malignant effusion leveles of HER-2 / neu were 5.12(3.14～8.15)ng / mL.The levels of CYFRA21-1 and HER-2 / neu in benign effusions were 15.81(7.01～48.56)ng / ml and 1.69(1.38～2.37)ng/ml respectively.There was significant defference between the two groups(P＜0.001);(3)We choose the ninetiesth percentile of the group of benign effusion as the cut-off between malignant and benign effusions, CYFRA 21-1 61.03ng / ml,HER-2 / neu 3.07ng / ml;(4)Examinated isolatedly the pleural effusion levels of CYFRA 21-1 and HER-2 / neu,the sensitivity,specificity of them were 70.0%.93.3%and 76.7%.93.3%respectively.The combined determination in pleural effusion of CYFRA 21-1 and HER-2/neu has a high sensitivity(93.O%),with a specificity of 87.0%which descented unobviously.Conclutions:(1)Using Medical thoracoscopy elevated significantly the accuracy of diagnosis and reduced the ratio of missing diagnosis.It was a safe and effitive method for diagnosis and defferential diagnosis in pleural effusion.(2)The levels of CYFRA 21-1 and HER-2 / neu between the groups of malignant and benign effusions were significantly defferent.The sensitivity,specificity and accuracy of them were all high,The detection of CYFRA 21-1 and HER-2 / neu in pleural effusion were of specified clinical sense in defferential diagnosis of malignant and benign effusions;(3)Combined detection of CYFRA 21-1 and HER-2 / neu elevated significantly the sensitivity of diagnosis and reduced the ratio of missing diagnosis.It has important clinical application value in defferential diagnosis of malignant and benign effusions.(4)Compared with isolated detection of tumor marker,The accuracy of Medical thoracoscopy was high.