| Objective:To explore the positive rate of diagnosis of malignant pleural effusion(MPE)by different examination techniques such as pleural effusion cytology,CT-guided needle biopsy,and internal thoracoscopy,and analyze its clinical significance.Methods : Collect the complete clinical data and diagnosed malignant pleural effusion from Dalian Central Hospital from January 2012 to December 2018.Age,gender,smoking history,and history of underlying diseases,tumor markers,imaging examinations,routine pleural effusion,exfoliated cell smears,cell block pathology,medical thoracoscopy(MT),CT-guided pleural biopsy,video-assisted thoracoscopic surgery(VATS)and other examination results were collected to analyze the clinical characteristics of malignant pleural effusion and the positive detection rate of different examination techniques.Result: Three hundred and four eligible patients were enrolled,including 150 males and 154 females,with an average age of(68.23±12.51)years.The unilateral pleural effusion was present in255 cases,the bilateral pleural effusion in 49 cases,and pleural effusion as the first symptom in79 cases.1.Etiology distribution of 304 cases of MPE: 202 cases of lung cancer(66.5%),19 cases of breast cancer(6.3%),17 cases of malignant mesothelioma(5.6%),11 cases of reproductive system tumors(3.6%),gastrointestinal tumors 9 cases(3%),hematological system tumors in 7 cases(2.3%),urinary system tumors in 2 cases(0.7%),thymoma in4 cases(1.3%),other 6 cases(2%),and 27 cases with unknown primary tumor(8.9%).Lung cancer and breast cancer are the most common causes of MPE,followed by malignant mesothelioma and female reproductive system tumors.2.The positive rate of pleural effusion cytology:Exfoliated cells smears of 258 patients,147 cases(57%)were positive,and cell pathological examination in 118 patients,87 cases(73.7%)were positive.The positive detection rate of cell block pathology was higher than that of exclaved cell smear(c2=9.668,P=0.002).103 patients were examined simultaneously by exfoliated cell smear and cell block pathology,38cases(36.9%)were positive for smear of exfoliated cells,and 76 cases(73.8%)were positive for cell block,83 cases(80.6%)were positive for the combined diagnosis.The combined application of the two techniques could further improve the detection rate(c2=42.238,P=0.000).3.The positive rate of tumor markers:The positive rates of serum carcinoembryonic antigen(s CEA),serum cytokeratin 19 fragment(s CYFRA21-1),and pleural effusion-carcinoembryonic antigen(p CEA)in lung cancer group were significantly higher than those in other tumor groups,and the difference was statistically significant(c2= 26.676,41.421,24.777,P=0.000,0.000,0.000).The expression levels of s CEA,s CYFRA21-1 and p CEA in lung cancer with thoracic metastasis(including pleura,lung and mediastinal lymph nodes)were significantly lower than those in lung cancer with distant metastasis(including liver,bone,brain,etc.),and the difference was statistically significant(Z=-4.837,-3.622,-2.321,P=0.000,0.000,0.020).4.The positive rate and microscopic characteristics of medical thoracoscopic(MT)examination:Seventy patients underwent both MT and pleural effusion cytology.MT was positive in 64 cases(91.4%)and pleural effusion cytological in 22 cases(31.4%).The positive rate of MT was significantly higher than that of pleural effusion cytological examination(c2=36.75,P=0.000).Medical thoracoscope prompt nodular lesions in 69cases(90.8%),pleural adhesions in 49 cases(64.5%),pleural hyperemia 21 cases(27.6%),pleural thickening in 4 cases(5.3%).The microscopic features of malignant pleural effusion are mainly nodular lesions and pleural adhesions,followed by pleural hyperemia and thickening.5.The positive rate of CT-guided puncture biopsy(including pleural biopsy and lung biopsy): Twenty-five patients with pleural biopsy under CT guidance were positive in 25 cases(100%),twenty-five patients with CT-guided lung biopsy were positive in23 cases(92%),and the total positive detection rate was 96%.Compared with medical thoracoscope positive rate(91.8%),no difference between the two results(c2=0.869,P=0.35).43 patients underwent both pleural effusion cytology and CT-guided needle biopsy,18 cases(41.9%)were positive for pleural effusion cytology,and 41 cases(95.3%)were positive for CT-guided puncture.The difference in the positive detection rate of the two diagnostic methods was statistically significant(c2=19.592,P=0.000).6.The positive rate of other tests: 49 patients had bronchoscopy,and 20 cases(40.8%)were positive.16 patients had VATS examination,and 16 were positive(100%).Ultrasound guided cervical or clavicular lymph node puncture in 6 patients,positive in6 cases(100%).There was 1 patient of surgical thoracotomy,and was positive(100%).46 patients underwent both bronchoscopy and pleural effusion cytology.27 cases(58.7%)were positive for pleural effusion,and 20 cases(43.5%)were positive for bronchoscopy.There was no statistically significant difference in the positive detection rate between the two diagnostic methods(c2=2.130,P=0.21).Conclusion: The positive rate of MPE detected by pleural effusion cell block pathology is significantly higher than that of exfoliated cell smear.The combination of the two can further increase the positive rate.The positive rate of CT-guided needle biopsy and medical thoracoscopy is better than that of pleural effusion cytology.For patients with suspected MPE,pleural effusion cytology is the first choice,followed by CT-guided needle biopsy or internal thoracoscopy. |
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