超声联合胸腔镜在胸腔积液良恶性诊断中的价值

Value of ultrasound combined with thoracoscopy in the diagnosis of benign and malignant pleural effusion

目的探讨超声联合胸腔镜在胸腔积液良恶性诊断中的价值。方法选取2020年1月~2021年3月在我院就诊的不明原因的胸腔积液患者102例,其中,良性患者76例,恶性患者26例,分析良恶性胸腔积液患者胸腔镜下形态、超声特征差异。分析胸膜厚度鉴别良恶性胸腔积液的价值和超声联合胸腔镜诊断良恶性胸腔积液的价值。结果良性患者病因均为结核性胸膜炎,恶性患者病因以胸膜转移性腺癌为主(88.46%);恶性组胸腔镜下胸膜肿块、胸膜瓷片状增厚的比例高于良性组(P<0.05),而胸膜充血水肿、胸膜粘连带比例分低于良性组(P<0.05);恶性组胸膜厚度、胸膜非均匀性增厚比例明显高于良性组(P<0.05),而强回声纤维分隔带比例低于良性组(P<0.05);胸膜厚度鉴别恶性胸腔积液的ROC曲线下面积为0.736(P<0.05),截断值为10.73 mm,敏感度和特异性分别为53.80%和99.70%;超声联合胸腔镜下形态诊断恶性胸腔积液的敏感度、特异性、准确率、阳性预测值和阴性预测值分别为76.92%、81.58%、80.39%、58.82%和91.18%。结论超声联合胸腔镜在胸腔积液良恶性诊断中有一定的应用价值。

Objective To explore the value of ultrasound combined with thoracoscopy in the diagnosis of benign and malignant pleural effusion.Methods A total of 102 patients with unexplained pleural effusion in our hospital from January 2020 to March 2021 were selected.The differences of thoracoscopic morphology and ultrasound characteristics between benign and malignant pleural effusion patients were analyzed.Results In the 102 patients,76 were benign and 26 were malignant.The etiology of benign patients was tuberculous pleurisy,while the main cause of malignant was metastatic adenocarcinoma of pleura,accounting for 88.46%.The proportions of pleural mass and porcelain like thickening in malignant group were higher than those in benign group(P<0.05).The proportions of pleural congestion and edema and pleural adhesions were lower than those in benign group(P<0.05).In the malignant group,the pleural thickness and the proportion of non-uniform pleural thickening were significantly higher than those in benign group(P<0.05).The proportion of hyperechoic fiber septum was significantly lower than that in benign group(P<0.05).The area under the ROC curve of membrane thickness in differentiating malignant pleural effusion was 0.736(P<0.05),and the cut-off value was 10.73 mm,the sensitivity and specificity were 53.80%and 99.70%,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of ultrasonography combined with thoracoscopic morphological diagnosis of malignant pleural effusion were 76.92%,81.58%,80.39%,58.82%and 91.18%,respectively.Conclusion Ultrasound combined with thoracoscopy has a certain value in the diagnosis of benign and malignant pleural effusion.