| The most efficient and cost-effective approach to the diagnosis of pleuraleffusion remains controversial.The respective diagnostic yields of effusioncytology,closed pleural biopsy and thoracoscopy are different. Pleural effusioncytology for malignant cells is the easiest way to diagnose malignant pleuraleffusion with good sensitivity and specificity,however,the accuracy ofdiagnosis only have50-60%.With the introduction of medicalthoracoscopy,the use of closed pleural biopsy for the diagnosis of cytologynegative malignant pleural effusion is gradually decreasing.However use ofthoracoscopy is limited due to its high cost and procedure relatedcomplications. Pleural biopsy as an invasive examination with smallerdamage, higher diagnostic yields and lower costs, still plays an irreplaceableimportant role.In this study, Trocar-style pleural biopsy is more efficient andsafer than the traditional biopsy equipments and worthy recommending.Objective: To evaluate the efficacy and safety of trocar-style pleuralbiopsy forceps for parietal pleural biopsy in patients with exudative pleuraleffusion,and compare with pleural effusion cytology.Methods:90patients of pleural effusion with unknown etiology wereselected from the patients admitted in the department of respiratory of TheFourth Hospital of Hebei Medical University in the period Jun.2011toSep.2012.The age ranged from30-74years old,and mean age (56.6±9.81)years old,there were55male patients and35female patients. Inclusioncriteria:(1)the patients’medical history over2weeks, repeated test by pleuraleffusion biochemical and routine examination confirmed was exudate effusionand cannot diagnose by bacteria culture,ADA and imaging studies,meanwhile,it must obtain the consent of the patient or the family members and signed theinformed consent.(2) Patients had no emphysema, bullae, superior vena cavaobstruction and pericardial effusion.(3) No breathing, circulation, liver and kidney failure, no hypoproteinemia and coagulation dysfunction.(4) Noabsolute thoracentesis contraindication.(5)Patients examed by thoracic cavityultrasound in order to locate the puncture point which the effusions depth over2cm. Chest CT scan confirmed the lesions were unilateral.(6) KPS score≧50.90patients were randomly divided into three groups according to thetime of hospitalization.There was pleural biopsy group, pleural effusioncytology group and the joint detection group,30cases in each group,there wasno significant difference between the three groups in age, genderthe and otherclinical information.We used C-type rocar-style pleural biopsy forceps tooperate parietal pleural biopsy.Biopsy performed only once in each patient,andlimited to three times in each biopsy. The specimens were placed in formalinsolution to save, the positive significance of histopathologic means operationwas successful. Such as muscle tissue, fat tissue and fiber necrotic tissue ornothing regarded as bite failed.The patients in pleural effusion cytology groupneed to located by the ultrasound, then perfomed thoracentesis and put thecatheter into the chest cavity in order to gather the effusion to cytologicalexamination, and there were at most three times for each patient, if the resultswere identified as negafive for three times.Joint detection group:Performedpleural biopsy at first after admission, then operate thoracentesis with thesame requirements as the former.Finally, compare the positive rate of diagnosis and the incidence ofadverse reactions and complications between the three groups,and contrast therate of pathological classification between pleural biopsy group and effusioncytology group.All the results use SPSS17.0to statistical analysis.Results:1Test Results:30patients of pleural biopsy group with positive diagnostic rate was76.67%(23/30). Pleural fluid cytology group diagnostic positive rate was43.33%(13/30).There were21cases(70%,21/30) confirmed the diagnosis bypleural biopsy in the joint detection group,and14cases(46.67%,14/30) with aclear diagnosis by effusion cytology, total of26cases diagnosed in joint detection group and the positive rate was81.67%(26/30). There was statisticaldifference in the three groups(x2=14.412,P=0.001<0.05).Pairwise comparisons among the three groups,we found that thediagnostic positive rate of pleural biopsy group was superior than effusioncytology group.It had statistically difference(x2=6.944,P=0.008<0.0125).Thepositive rate of diagnosis of joint detection group was also higher than theeffusion cytology group.It also had statistically difference(x2=12.381,P=0.000<0.0125).There was no significant difference betweenpleural biopsy group and joint detection group(x2=1.002,P=0.317>0.0125).Contrast the rate of pathological classification between pleural biopsygroup and effusion cytology group. The pleural biopsy confimed23cases,including17cases of adenocarcinoma,1cases of tuberculous pleurisy,squamous cell carcinoma and pleural mesothelioma, the remaining3cases ofthe cancer cells unable to classify,and the rate of pathological classification is86.96%(20/23). The pleural effusion cytology group confimed13cases,5cases of adenocarcinoma, the remaining8cases were cancer cells but alsounable to classify any further and the rate was38.46%(5/13).The rate ofpathological classification of biopsy group was better than the effusioncytology group.There was statistical difference in the twogroups(P=0.006<0.05).2Complications and adverse reactions:Incidence of pneumothorax:3cases happened in the pleural biopsygroup(10.0%), joint detection group had5cases(16.67%),and only2cases(6.67%) occurred in the pleural effusion cytology group.They were alliatrogenic pneumothorax,and the volume of pneumothorax less than10%. Nostatistically significant difference among the three groups in the incidence ofpneumothorax(P=0.592>0.05).Incidence of chest pain:4cases were found in the pleural biopsy group(13.33%),and the effusion cytology group got2cases(6.67%),7cases(23.33%) happened in the joint detection group. No statistically significant difference among the three groups in the incidence of chest pain(P= 0.217>0.05).Vasovagal reaction:There was1cases(3.33%) in the pleural biopsy groupand effusion cytology group.2cases(6.67%) occurred in the joint detectiongroup.They still got no statistically significant difference(P=1.00>0.05).There was no hemothorax, fever and other complications occur amongthe three groups.Conclusions:1.The diagnostic yields of pleural biopsy group and jointdetection group were both superior to the effusion cytology group which inexudative pleural effusion of unknown etiology,and there was no significantdifference in the contrast between pleural biopsy group and joint detectiongroup.2.The diagnostic positive rate of pleural effusion cytology was inferiorto the pleural biopsy,And the rate of pathological classification was also lowcompared with the pleural biopsy.However,as a routine examination is verynecessary,because of its convenient and safe, particularly when malignancy issuspected.3.As a new type of closed pleural biopsy equipment trocar-stylepleural biopsy forceps is easily available, and has minimal complications, alsocost-effective and safe. |
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