| ObjectivePleural effusion is one of the most common pleural diseases.In respiratory system,25%-30% diseases of respiratory system are related to pleural diseases.Pleural diseases are a series of diseases characterized by pleural effusion that arise from anatomic structure and biological dysfunction of pleura and pleural cavity. The causes of various pleural and pleurovac diseases are complicate. Pleural and pleurovac diseases occur in primary pleura tissues, or induced by the diseases of lung, chest wall, diaphragm or abdominal organs, or caused by systemic diseases such as systemic connective tissue disease, leukemia, lymphoma, etc. Similarly, Hypoproteinemia caused by congestive heart failure, cirrhosis, nephrotic syndrome malnutrition can also lead to pleural effusion that induce pleural and pleurovac diseases.To data, the differential diagnosis of benign and malignant pleural effusion lacks unified standard for doctors to make accurate diagnosis.If doctors can understand the exact reasons of pleural effusion as soon as possible that it is great of clinical value.Therefore, investigating diagnostic indexes of pleural effusion such as cytological examination of pleural effusion,levels of the ADA,LDH,CEA in pleural effusion, is significant for the diagnosis of pleural diseases. In our study, we used modified pleura Abrams needle to diagnose agnogenic pleural effusion. So we could evaluate the clinical significance and security of modified pleura Abrams needle for diagnosis of agnogenic pleural effusion. In our study, we also detected adenosine deaminase (ADA), lactate dehydrogenase (LDH), ratio of carcinoembryonic antigen (CEA) in pleural effusion and serum, cytological examination, combining with biopsy of modified pleura Abrams needle to investigate their differential diagnosis significances for tuberculous and malignant pleural effusion.Clinical data and methods(1) Clinical dataDuring January 2000--December 2010,570 patients(365 male and 205 female) with pleural effusion, Zhu Jiang hospital, aging at 48.2±19.4. divided into Tubercle (TB) group and tumor group. Biopsy of pleura, pleural fluid cytology examination, CEA, ADA, LDH of pleural fluid, and serum CEA examination were performed.(2)Methods:The modified Biopsy technique in this study included two aspects:1, improvement of the pleural biopsy needle as the modified Abrams needle; Modified Abrams needle is composed of three parts.①thick with a depression slot, barb jacket tube to take the pleura tissue;②concave cutting needle;③stuffed inner needle. Process of operations as follow:Firstly, routine ultrasound locatization were carried out before operation, after routine disinfection and local anesthesia, the modified Abrams needle was inserted into the chest wall vertically, then adjusted the angle between the needle body and the chest wall to 30 degree, when the jacket tube tightly hooked pleura, we pushed the concave cutting needle totally into the chest to get parietal pleural tissue into the jacket tube. We chose three white parietal pleural tissues of 3.6.9 point. Parietal pleural tissues were immediately placed in the 10% Paraformaldehyde for pathology examination. Pathological results were tuberculous or malignant that indicate positive. Before the biopsy of pleura, we drew pleural effusion for routine, biochemistry and cytological examination. Pleural effusion was centrifugated to collect supernate for test. We also obtained peripheral blood for CEA detection. AEROSET biochemistry analyzer (Abbott Laboratories, American) for detection of ADA,LDH, AXSYM automatic immunization analyzer (Abbott Laboratories, American) for detection of CEA. All performances were strictly according to manufacture introductions.(C) Statistical analysis:SPSS 13.0 software is used for statistical analysis, all metrology data are presented as Mean±SD. Sample mean between the two groups using independent sample t test. Enumeration data using Pearson 2 test. A P value less than 0.05 was considered to indicate a significant difference..ResultsPathology of pleura biopsyAll 570 patients were performed biopsy of pleura, altogether 647 times.552 cases for biopsy of pleura were succeeded at first time(552/570). Among the 647 cases, there was no pleura tissue inl8 samples.335 samples were successful at first time to get etiological diagnosis pleural pathology results(335/570), another 235 samples without etiological diagnostic value were non-specificity inflammation or no pleura tissue. Patients unsuccessfully obtained pleural tissue at first time were performed second and third biopsy of pleura to collect sample. In our study, total positive rate was 65.1%(371/570),212 tubercle,1 granulomatous inflammation,253 chronic inflammation,158 tumors.158 tumors 130 included adenocarcinoma,4 squamous Carcinoma,4 small cell carcinoma,16 malignant mesothelioma of pleura,1 pleural metastasis of nasopharyngeal carcinoma,2 pleural metastasis of breast cancer,1 pleural metastasis of suprarenal epithelioma.394 cases of 570 were performed cytological examination. Tumor cell and/or doubtful tumor cell were found in 75 cases (19%). Among all above 75 cases, cytological examination found tumor cell and/or doubtful tumor cell at first time, second time, third time and forth time separately were 58 cases (14.7%),13 caces (14.7%),3 cases (0.8%),1 case (0.3%).The tumor positive rate of all patients was 50%(62/124). There were 13 cases found tumor cell in all patients whose pathology results were negative. There was 1 case found tubercle bacillus.Comparison between malignant group(MG) and tubercle group(TG):The level of CEA in MG was higher than that in TG. (p<0.001) The level of ADA in TG was higher than that in MG. (p<0.001).The level of CEA,ratio of hydrothorax CEA and peripheral blood CEA in MG were higher than that in TG. The level of LDH in TG no chang than that in MG(P=0.206).Complications of pleural biopsy:570 patients were administrated pleural biopsy for total 647 times.15 patients occurred pneumothorax 2.31%(15/647), most of patients were administrated expectant treatment or thoracentesis to draw air for lung recovery, only one patient needed thoracic close drainage for 3 days; otherwise,2 patients occurred bleeding (2/647), only 1 patient with bleeding need thoracic close drainage and got better after 5 days. All patients caused pleural reaction for 24 times 3.7% (24/647), When pleural reaction occurred, we ceased the operation of pleural biopsy at once, then supplied patients with oxygen. Patients got better after bedding peacefully.Conclusion1.The improved biopsy of pleura is a simple, less invasive, rapid, safe,easy operation,high achievement ratio,fewer complication method,has high diagnostic value of unkown pleural effusion.2.The lever of ADA, CEA in hydrothorax, the ratio of CEA in hydrothorax and blood,and exfoliative cytologic examination have substaintial diagnostic value. |
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