Influence Factors And Combined Value Of Medical Thoracoscopy In The Diagnosis Of Tuberculous Pleural Effusion

Background:To explore the influence factors of medical thoracoscopy(MT)in diagnosis of TPE,evaluate the combined accuracy of pleural effusion adenosine deaminase(PEADA),peripheral blood monocytes(MONO)and pleural effusion mononuclear cells(PEMC)with MT for the diagnosis of TPE.Methods:Consecutive patients with pleural effusions January 2013 to December 2017 in Shandong Provincial Hospital were enrolled.The demographic,laboratory and pathologic information of patients were retrospectively collected,factors affecting TPE in MT diagnosis were analyzed by logistics regression analysis.The diagnostic value was analyzed using receiver operating characteristic(ROC)curves.Results:A total of 190 patients were eligible according to the inclusion and exclusion criteria,with the median age of 54(age from 17 to 84),including 135 males(71.05%)and 55(28.95%)females.123 patients were confirmed to have TPE and 67 cases divided into NTPE group.1.TPE and NTPE group showed statistically significant difference in age(48.32 +16.94 vs 57.39 ± 13.87,P<0.001).The incidence of basic diseases were 42.78%(52/123)and 62.69%(42/67),(?2=7.228,P=0.007).There was no significant difference in gender,weight and other baseline data(P>0.05).2.Thoracoscopy performance:(1)27(14.21%)cases with millet nodules,(2)66(34.74%)cases with several white nodules,(3)14(7.37%)cases with pleural thickening,(4)24(12.63%)patients with pleural congestive edema,(5)121 patients(63.68%)with extensive adhesion.The differences between two groups were remarkable in millet nodules,extensive adhesion and pleural thickening(?2=8.042,4.433 and 5.577,respectively,P<0.05).3.Differences existed in intraoperative intervention(?2=12.687,P<0.001).Fever(?2=7.564,P=0.006)and cough(?2=7.818,P=0.005)were more common in TPE group.However,there were no significant differences in other factors(P>0.05).4.Logistic regression showed that age?35 years,miliary nodule,extensive adhesion and intraoperative intervention were independent risk factors(OR values were 5.587,6.232,2.259 and 3.887,respectively)affecting the diagnosis of TPE.5.The median duration with miliary nodule or not was 24 days and 33 days respectively(Log Rank P=0.038<0.05)in female by KM analysis.It were 68 days and 29 days respectively for the elderly patients with "little adhesion" and "extensive adhesion"(Log Rank P=0.037<0.05).6.143 cases were diagnosed to TPE probably by MT with 100%sensitivity,70.1%specificity and 29.9%misdiagnosis rate,while 123 cases were diagnosed with TPE finally.7.The sensitivities and specificities were as follows:PEADA(>16.9U/L)88.6%and 67.2%,MONO(>8.95%)57.7%and 71.6%,and PEMC(>88.5%)65.0%and 74.6%for the diagnosis of TPE.The cutoff value of PEADA in this study was 16.9U/L,which was better than the traditional ADA of 40U/L.8.The combination of PEADA,MONO,PEMC achieved a better diagnostic accuracy for TPE,combined diagnostic value of the three slightly lower than MT(0.839 vs.0.903)after adjustment,but improve speciality and PPV,reduce the misdiagnosis.The difference of diagnostic strategies was smaller(AUC 0.884 vs 0.896)in patients with PEADA<40U/L(p<0.001).9.The diagnostic value of MT combined with PEADA,MONO and PEMC was significantly improved(AUC 0.962,SE 95.1%,SP 85.1%,PPV 92.1%,misdiagnosis rate 14.9%,P<0.001)after adjusting.Conclusion:We found that age,intraoperative intervention,microscopic miliary pleural nodules,extensive pleural adhesion,basic diseases could affect the diagnosis.Miliary pleural nodules in female and extensive pleural adhesion in elderly people were associated with higher risk.Combining PEADA,MONO,PEMC and thoracoscopic biopsy can diagnose TPE commonly.