超声引导下胸膜活检与内科胸腔镜活检诊断一致性分析

Analysis of consistency between ultrasound-guided pleural biopsy and medical thoracoscopy pleural biopsy in diagnosis

目的通过回顾性分析超声引导下胸膜活检(ultrasound-guided pleural biopsy,USPB)和内科胸腔镜胸膜活检(medical thoracoscopy pleural biopsy,MTPB)的胸腔积液患者临床资料,分析两种取材方法的选择和诊断一致性。方法选择2020年10月至2023年5月由我院呼吸与危重症医学科进行超声引导下胸膜活检和内科胸腔镜胸膜活检的胸腔积液患者74例,对临床资料、胸腔积液特征、取材质量和病理诊断价值进行分析。结果先行超声引导下胸膜活检后再行内科胸腔镜胸膜活检患者USPB+MTPB组40例,取材的病理诊断价值并不优于直接行内科胸腔镜胸膜活检患者MTPB组34例,差异具有统计学意义(P<0.001)。40例USPB+MTPB组患者中,USPB和MTPB所取标本大小0.004(0.003,0.011)mm^(3)和0.105(0.026,0.230)mm^(3),差异具有统计学意义(P<0.001)。进一步分析,USPB取材病理诊断价值并不优于MTPB,差异具有统计学意义(P<0.001)。USPB和MTPB的阳性率是65.00%和95.00%;阴性率分别是35.00%和5.00%。USPB和MTPB的可靠性评价指标卡帕值(Kappa value)=0.038。结论MTPB在阳性诊断率、取材质量和病理诊断价值方面优于USPB,临床在二者的选择上应结合患者个体化、安全性及可及性等进行综合考虑。

Objective The clinical data of patients with pleural effusion by ultrasound guided pleural biopsy(USPB)and medical thoracoscopic pleural biopsy(MTPB)were retrospectively analyzed,to explore the selection and diagnostic consistency of these two sampling methods.Methods 74 patients with pleural effusion by USPB and MTPB were recruited in the Department of Respiratory and Critical Care Medicine of our hospital from October 2020 to May 2023.The general clinical data,pleural effusion characteristics,sample quality,and pathological diagnostic value were analyzed.Results The pathological diagnostic value of patients who underwent USPB before undergoing MTPB(USPB+MTPB group)40 cases was not superior to those who directly underwent MTPB(MTPB group)34 cases,and the difference was statistically significant(P=0.007).Among the 40 patients in the USPB+MTPB group,the sample sizes of USPB and MTPB were 0.004(0.003,0.011)mm^(3) and 0.105(0.026,0.230)mm^(3),with statistically significant differences(P<0.001);the pathological diagnostic value of USPB is not superior to that of MTPB,and the difference is statistically significant(P<0.001).The positive rates of USPB and MTPB were 65.00%and 95.00%,respectively;the negative rates were 35.00%and 5.00%,respectively.The reliability evaluation index Kappa value of USPB and MTPB is 0.038.Conclusion MTPB is superior to USPB in terms of positive diagnostic rate,sample quality,and pathological diagnostic value.Clinicians should also consider patient individualization,safety,and accessibility when selecting the two.