The Diagnostic Value Of Medical Thoracoscopy For Undiagnosed Pleural Effusion

Background:Pleural effusion is a common clinical sign.Every year approximately one million patients develop pleural effusion resulting from various diseases.Etiological treatment is one of the most significant mode of curing pleural effusion.Multiple methods including pleural effusion routine,biochemical and clinical tumor markers,microbial etiology diagnosis and cytological method,can facilitate the identification of the causes of pleural effusion.However,some patients can't be get a definite diagnosis.Medical thoracoscope is an invasive operation technology,mainly used in the above methods can't confirmed the diagnosis and treatment of patients with pleural effusion.Medical thoracoscopy has small trauma,less complication,lower cost low,the advantages of shorter hospitalization time.Medical thoracoscopy is helpful not only for the diagnosis of pleural effusion,but also for the treatment of pleural diseases.Medical thoracoscope has immeasurable future in clinical medicine.Objectives:The aim of this study is to observe endoscopic features of different causes of pleural effusion and to explore the clinical value and safety of medical thoracoscopy in the diagnosis of unexplained pleural effusion.Methods:A retrospective analysis of 161 patients with unexplained pleural effusion in the first hospital of jilin university from June 2013 to February 2017,we observed the morphology and distribution of pleural lesions and obtained pathological gold standard,got diagnosis rate of thoracoscopy for unexplained pleural effusion and disease spectrum.We did statistical analysis of laboratory indexes,such as hydrothorax ADA,LDH,CEA,serum CRP,ESR,TB T spots.We analyzed color of pleural effusion and the relationship between the endoscopic diagnosis and pathological diagnosis.Finally,we followed these patients with negative pathological results closely.The index was not included in the statistical analysis for the incomplete records.We used the mean plus and minus standard deviation to describe the measurement data which obeyed the normal distribution,and the median(four percentile),M(P25-P75),was used to describe the data that were not subject to the normal distribution.The count data was represented by the constituent ratio(%).For the measurement data with normal distribution,the two independent sample t test was used to compare the differences between groups.Chi square test was used to compare the count data and calculate the risk ratio.We drawed the ROC curve,and selected the best sensitivity,specificity and cut-off value according to the area under the curve.The difference was statistically significant with P < 0.05.Use SPSS 18.0 software packages for data analysis.Results:1.The diagnostic rate of pleural effusion was 84.5%.The diagnostic rate pleural effusion in one side was significantly higher than that in both sides(P=0.016)and there was no significant difference between the elderly and the non elderly(P=0.889).The main causes of pleural effusion in this group were tuberculosis and tumor.The average age of patients with tuberculous pleural effusion was lower than that of malignant pleural effusion(P<0.01=.2.The level of ADA and the positive rate in TPE was significantly higher than that of MPE(P < 0.05),the difference was statistically significant.The level of CEA level and positive rate in MPE were significantly higher than TPE(P < 0.05),the difference was statistically significant.The TPE diagnosis of pleural ADA area under the ROC curve was 0.985,with higher diagnostic accuracy,the MPE diagnosis of pleural CEA area under the curve was 0.916,with higher diagnostic accuracy,serum C-reactive protein and blood sedimentation in the diagnosis of TPE area under the ROC curve were 0.895 and 0.757,with secondary accuracy in diagnosis.Tuberculosis T spot has high sensitivity and low specificity in the diagnosis of TPE.3.In this study,there were fewer complications(7.5% in the operation and 11.75% after operation),and the safety was higher.No severe complication such as cardiac respiratory arrest,massive hemorrhage,air embolism and pulmonary edema was found.4.The coincidence rate of the diagnosis and pathological diagnosis was 66.7%,the coincidence rate of TPE was 70.7%,and the coincidence rate of MPE was 50.5%.PE color was associated with benign and malignant lesions(P < 0.001).Multiple nodules were associated with the type of disease(P=0.039),and there was no significant correlation between benign and malignant lesions(P=0.055).5.We followed 25 patients with negative pathological results,and we found specific etiology of 18 cases(72%),including 9 cases of tuberculous pleurisy,1 case malignant mesothelioma,1 case squamous cell carcinoma,1 case pleural metastatic carcinoma,2 cases pneumonia associated with pleural effusion,2 cases of empyema,2 cases of diseases of pleural effusion.Among them 15 cases were benign pleural effusion(83.3%).Conclusions:1.In the PE spectrum of unknown cause,tuberculosis and tumor were the most common.2.According to endoscopic features of different causes and the color of pleural effusion,the clinician can preliminarily judge whether it was benign or malignant.3.we found specific etiology in the majority of patients with negative pathological results after a year of follow-up,and most of them were benign.