Diagnosis Value Of Medical Thoracoscopy Combine With Rapid On-site Evaluation In Undiagnosed Pleural Effusion

BackgroundPleural effusion is a common clinical symptom.With the increase of the incidence of lung cancer and tuberculosis,the incidence of pleural effusion increases year by year.Early detection of etiology and timely treatment can improve the treatment effect and prognosis of patients.The etiology of pleural effusion in most patients can be determined based on clinical manifestations,imaging,pleural effusion examination and closed pleural biopsy.However,10% ? 25% of patients have no definite diagnosis after pleural effusion examination and closed pleural biopsy.Then,medical thoracoscopy is recommended according to the relevant guidelines.Medical thoracoscope can dynamically observe the thorax after entering the thorax,and find out the pathological changes for biopsy,so it has high diagnostic value.However,some pleural lesions are not typical under the medical thoracoscope,and it is difficult to distinguish them from normal tissues.Therefore,the possibility of false negative biopsy materials under thoracoscope in internal medicine is difficult to guarantee the validity of biopsy materials.With the continuous development of pulmonary interventional examination technology and the emergence of new techniques and examination methods,the requirements for the quality of samples are improved,and rapid on-site evaluation(ROSE)is widely used in interventional respiratory diseases.ROSE can make assessment on the sampling site and judge whether the sampling is ideal,so as to improve the success rate of sampling,reduce the number and time of ineffective biopsy,and reduce related risks.Previous studies have reported ROSE has high clinical application value in mediastinal lymph node puncture and lung biopsy.Whether the application of ROSE in medical thoracoscopy can improve the success rate of onesampling,reduce the number and time of biopsy,and improve the diagnostic efficiency is currently lacking relevant literature reports.Therefore,the purpose of this study was to explore the diagnostic value of thoracoscopy combined with ROSE in the treatment of unexplained pleural effusion and the clinical application value of ROSE.MethodA retrospective analysis was performed from January 2016 to December 2019 with unexplained pleural effusion patients.We performed medical thoracoscopy on all patients who were considered diagnosed as pleural effusion of unknown aetioloty.Excluding the influence of operation techniques and other factors,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 general basic clinical data of the two groups were collected,the frequency of pleural biopsy,biopsy time,operation time,secondary inspection rate,complications and diagnosis rate of the two groups were compared,the consistency between ROSE results and postoperative pathology was analyzed,the ROC curve was drawn,and the diagnostic value of ROSE for unknown pleural effusion was evaluated with the area under the ROC reference curve.Result1.The number and time of biopsy of ROSE group were(4.98±1.51)and(17.56±4.57)min,respectively.The number and time of biopsy of non-combined group were(6.07±1.34)and(21.04±6.18)min and there were statistically significant between the two groups.The operation time of ROSE group was(38.23±8.43)min,and that of the non-combined group was(42.15 ± 8.78)min.There was a significant difference between the two groups(P<0.05).There was no significant difference in the bleeding rate and secondary examination rate of ROSE group compared with that of the non-combined group.But we found no significant difference in complication rate between ROSE and non-combined groups(23.07% vs 26.08%,P=0.922).2.The ROSE results were compared with the postoperative pathological results,which showed that the consistency rate of malignant lesions was 81.48%(22/27),and the consistency rate of benign lesions was 95.23%(20/21).ROSE has good concordance with routine pathological examination in the diagnosis of unidentified pleural effusion(Kappa value was 0.699,P<0.001).3.Area under the curve of ROSE for the diagnosis of malignancy was 0.875(95%CI: 0.773-0.977,P<0.05),with a sensitivity of 79.3%,specificity of 95.7%,diagnostic accuracy of 86.5%,positive predictive value of 95.9% and negative predictive value of78.6%.And Area under the curve of ROSE for the diagnosis of benign lesions was0.922(95% CI: 0.836-1.000,P<0.05),with a sensitivity of 91.3%,specificity of 93.1%,diagnostic accuracy of 92.3%,positive predictive value of 91.3% and negative predictive value of 93.1%.4.In the ROSE group,48 patients were diagnosed by thoracoscopic biopsy,and 4patients were not diagnosed.Of the 46 patients in the non-ROSE group,41 were diagnosed by thoracoscopic biopsy in the non-combined group.There was no statistically significant difference in diagnosis rate between ROSE and non-combined groups for unidentified pleural effusion(92.30% vs 89.13%,P<0.05).Conclusion1.Medical thoracoscopy combined with ROSE can reduce procedure times and biopsy time without increasing the risk of bleeding.2.ROSE has good concordance with routine pathological examination in the diagnosis of unidentified pleural effusion,which could preliminarily judge the benign and malignant pleural effusion.3.Medical thoracoscopy combined with ROSE has a high diagnostic value in the unexplained pleural effusion,and ROSE has a high clinical value in the application of medical thoracoscopy,which is worthy of clinical promotion and application.