Diagnostic Study Of Bronchoscopy Instead Of Video-assisted Thoracoscopy And Tumor Markers In Malignant Pleural Effusion

Objective:To investigate the diagnostic value of bronchoscopy instead of thoracoscopy and tumor markers in malignant pleural effusion.Methods:In this study,80 patients with pleural effusion in the inpatient department of respiratory medicine in Shaoyang Central Hospital from 1st January 2017 to 31 December 2017 were studied.Pleural biopsy specimens were taken by bronchoscope instead of thoracoscopy,and pleural effusion and serum specimens were also taken to detect multiple tumor markers.Results:Bronchoscopic thoracoscopy was successfully performed in 80 patients with pleural effusion without any adverse reactions.Finally,28 patients were diagnosed with malignant pleural effusion,48 patients with tuberculous pleural effusion,and 4 patients were undiagnosed.Among the 28 patients diagnosed with malignant pleural effusion,the average levels of CEA,CYFRA21-1 and NSE in pleural effusion were much higher than the normal values.Compared with the tuberculous pleural effusion group,the levels of CEA,CYFRA21-1and NSE in pleural effusion were also significantly increased(P < 0.05).The mean level of CEA in the serum of 48 patients diagnosed with tuberculous pleurisy was lower than the positive value,and the mean level of CYFRA21-1 was slightly higher than the positive value,and the difference between the two groups was statistically significant(P < 0.05).The serum NSE level of patients in both groups was lower than the positive standard,and there was no significant difference between the malignant pleural effusion group and the tuberculous pleural effusion group(P>0.05).The mean levels of CEA,CYFRA21-1 and NSE in pleural fluid of patients with malignant pleural effusion were all higher than the positive boundary value,and the differences were statistically significant compared with the mean levels in serum(P < 0.05).Application the ROC curve analysis of CEA,NSE,CYFRA21-1 for benign and malignant pleural effusion combined diagnostic test evaluation,the results showed the area under the curve of CEA+CYFRA21-1 ? CEA+NSE ? CYFRA21-1+NSE ?CEA+CYFRA21-1+NSE are 0.983,0.837,0.878,0.948 respectively(P < 0.05).According to the results of joint detection specificity of above 90.0%,the sensitivity of CEA+CYFRA21-1 ? CEA+NSE ?CYFRA21-1+NSE?CEA+CYFRA21-1+NSE were 80.9%,57.5%,71.4% and 89.3%,respectively.The combined detection of CEA+ CYFRA21-1 +NSE has the highest sensitivity of 89.3%,which has a high value of differential diagnosis.Conclusions:Diagnostic study of bronchoscopy instead of video-assisted thoracoscopy for malignant pleural effusion is confirmed.Detection of carcinoembryonic antigen,cytokeratin 19 and neuron-specific enolase in pleural effusion is helpful for differential diagnosis of benign and malignant pleural effusion.