Diagnostic Value Of Medical Thoracoscopy In Undiagnosed Pleural Effusion

Background and Objectives:medical thoracoscopy is an important tool for interventional operation of respiratory physicians.It can directly enter the pleural cavity,observe,get specimens and treatment,and has important diagnostic value for undiagnosed pleural effusion.With the continuous development of thoracoscopy,this technique is playing a more and more important role in the diagnosis and treatment of pleural disease.In the past twenty years,medical thoracoscopy has been developing rapidly in China.It is a common method to diagnose undiagnosed pleural effusion through medical thoracoscopy.ral effusion is usually associated with a potential malignant tumor or tuberculosis,both of which need to be diagnosed in time for treatment.Thoracentesis can sometimes draw a pathological conclusion,which is a suitable first step.However,how to deal with undiagnosed exudative pleural effusion is still controversial.Because of the influence of historical and practical factors,the method of this examination is quite diverse.At present,with the increase of pleural disease,the undiagnosed pleural effusion is becoming more and more common in the clinic.It is necessary to establish evidence-based evidence for diagnosis and treatment of thoracic diseases,especially for the better application of closed pleural biopsy,medical thoracoscopy,video-assisted thoracoscopic surgery and thoracotomy.Ultimately,doctors and patients consider these options under the multidisciplinary background,combine the skills and expertise of medical and thoracic surgeons,and provide a more comprehensive treatment for pleural diseases,which is beneficial for patients.We now need more clinical data from our clinicians to clarify the advantages and disadvantages of various tests.This study reviewed the clinical data of 143 patients with undiagnosed pleural effusion.All of these patients completed the examination of the medical thoracoscopy.This can provide more clinical data for the medical thoracoscopy.According to the data of the unexplained pleural effusion,the prediction model of the good and evil nature of the hydrothorax is discussed by nomogram analysis,which is of great significance to the clinical work.Methods: a retrospective analysis of 143 cases of undiagnosed pleural effusion from January 2014 to May 2017 in the Department of respiratory medicine of Shanghai Changzheng Hospital.Multivariate Logistic regression analysis and Nomogram analysis were carried out on the characteristics of benign and malignant pleural effusion throughmicroscopic manifestations,pathological findings and complications.To establish a prediction model for the good and evil nature of the hydrothorax.Results: Among the 143 patients,there were 82 cases of pleural metastasis of malignant tumor,including 55 cases of pleural metastasis of lung adenocarcinoma(68%),4 cases of pleural metastasis in small cell carcinoma of the lung(5%),Unidentified 4cases of pulmonary origin(5%),Pleural metastasis of breast cancer in 5 cases(6%),1pleural metastasis of gastric cancer(1%),and 1 cases of pleural metastasis of renal carcinoma(1%).There were 1 cases(1%)of ovarian tumors,1 cases of thymic carcinoma(1%),10 cases of malignant pleural metastasis(12%)and 6 cases of pleural primary tumor,of which 3 cases were malignant pleural mesothelioma(50%),and 3cases(50%)were benign pleural mesothelioma.In 42 cases of benign lesions,granulomatous lesions were found in 28 cases(67%),degenerative exudative necrosis in6 cases(14%),angiofibrosis in 4 cases(9.5%),and 4 cases(9.5%).Pathological findings were not clear in 8 cases.3 cases had pleural adhesions and 2 cases had no abnormal biopsy under microscope.Through the Nomogram analysis of the data of the pleural effusion of unknown cause,the prediction model of the good and evil nature of the hydrothorax was established.The predictive factors of the benign and malignant pleural effusion were Cr,ESR,CEA and ADA.Conclusions:In malignant pleural effusion,malignant pleural effusion is the most common cause of malignant pleural metastasis,which is most common in the pleural metastasis of lung cancer,up to 70%.Pulmonary adenocarcinoma is the most common in the pleural metastasis of lung cancer,small lung cancer and almost no lung squamous cell carcinoma.Pleural metastasis of adenocarcinoma was the most common.Pleural mesothelioma is also one of the causes of malignant pleural effusion,but it is rare.Conclusion two: tuberculosis is the most common benign pleural effusion in unknown causes,reaching more than 90%.Conclusion three: multiple nodular changes and pleural hyperplasia are mostly seen in malignant pleural effusion in the pleural effusion of unexplained pleural effusion.The formation of adhesive band,inflammatory change,pleural congestion,and miliary nodular changes are often seen in the benign pleural effusion.Conclusion four: medical thoracoscopy has high safety and fewer complications.Conclusion five: Cr,ESR,CEA,ADA and microscopic appearance are the predictor factors of benign and malignant pleural effusion.Medical thoracoscopy plays an important role in the diagnosis of unexplained pleural effusion.It is a very usefulinterventional tool for physicians.