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Abstract：
BACKGROUND: This study was to investigate the diagnostic value of percutaneous closed pleural brushing (CPBR) followed by cell block technique for malignant pleural effusion (MPE) and the predictive efficacy of pleural fluid carcinoembryonic antigen (CEA) for epidermal growth factor receptor (EGFR) mutations in lung adenocarcinoma patients with MPE.
METHODS: All patients underwent closed pleural biopsy (CPB) and CPBR followed by cell block examination. MPE-positive diagnostic rates between the two methods were compared. Univariate and multivariate analyses were performed to determine factors influencing the EGFR mutations. Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of pleural fluid CEA for EGFR mutations.
RESULTS: The cumulative positive diagnostic rates for MPE after single and twice CPBR followed by cell block examination were 80.5% and 89.0%, higher than CPB (45.7%, 54.3%) (P < 0.001). Univariate analysis showed that EGFR mutation was associated with pleural fluid and serum CEA (P < 0.05). Multivariate analysis showed that pleural fluid CEA was an independent risk factor for predicting EGFR mutation (P < 0.001). The area under the curve (AUC) of pleural fluid CEA for EGFR mutation prediction was 0.774, higher than serum CEA (P = 0.043), but no difference with the combined test (P > 0.05).
CONCLUSIONS: Compared with CPB, CPBR followed by the cell block technique can significantly increase the positive diagnostic rate of suspected MPE. CEA testing of pleural fluid after CPBR has a high predictive efficacy for EGFR mutation in lung adenocarcinoma patients with MPE, implying pleural fluid extracted for cell block after CPBR may be an ideal specimen for genetic testing.
METHODS: All patients underwent closed pleural biopsy (CPB) and CPBR followed by cell block examination. MPE-positive diagnostic rates between the two methods were compared. Univariate and multivariate analyses were performed to determine factors influencing the EGFR mutations. Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of pleural fluid CEA for EGFR mutations.
RESULTS: The cumulative positive diagnostic rates for MPE after single and twice CPBR followed by cell block examination were 80.5% and 89.0%, higher than CPB (45.7%, 54.3%) (P < 0.001). Univariate analysis showed that EGFR mutation was associated with pleural fluid and serum CEA (P < 0.05). Multivariate analysis showed that pleural fluid CEA was an independent risk factor for predicting EGFR mutation (P < 0.001). The area under the curve (AUC) of pleural fluid CEA for EGFR mutation prediction was 0.774, higher than serum CEA (P = 0.043), but no difference with the combined test (P > 0.05).
CONCLUSIONS: Compared with CPB, CPBR followed by the cell block technique can significantly increase the positive diagnostic rate of suspected MPE. CEA testing of pleural fluid after CPBR has a high predictive efficacy for EGFR mutation in lung adenocarcinoma patients with MPE, implying pleural fluid extracted for cell block after CPBR may be an ideal specimen for genetic testing.
摘要：
背景：本研究旨在探讨经皮闭式胸膜刷检(CPBR)后细胞阻滞技术对恶性胸腔积液(MPE)的诊断价值及胸膜液癌胚抗原(CEA)对表皮生长因子受体(EGFR)突变的预测作用。
方法：所有患者均接受闭式胸膜活检（CPB）和CPBR，然后进行细胞块检查。比较两种方法的MPE阳性诊断率。进行单变量和多变量分析以确定影响EGFR突变的因素。采用受试者工作特征(ROC)曲线分析胸水CEA对EGFR突变的预测效果。
结果：单次和两次CPBR随后进行细胞块检查后，MPE的累积阳性诊断率分别为80.5%和89.0%，高于CPB（45.7%，54.3%)(P<0.001)。单因素分析显示EGFR突变与胸腔积液和血清CEA相关(P<0.05)。多因素分析显示胸腔积液CEA是预测EGFR突变的独立危险因素(P<0.001)。胸水CEA预测EGFR突变的曲线下面积(AUC)为0.774,高于血清CEA(P=0.043),但与联合检验无差异(P>0.05)。
结论：与CPB相比，CPBR跟着细胞阻滞技巧可显著增长疑似MPE的阳性诊断率。CPBR后胸腔积液CEA检测对肺腺癌MPE患者EGFR突变有较高的预测效果,暗示CPBR后提取胸膜液用于细胞块可能是基因检测的理想标本。
方法：所有患者均接受闭式胸膜活检（CPB）和CPBR，然后进行细胞块检查。比较两种方法的MPE阳性诊断率。进行单变量和多变量分析以确定影响EGFR突变的因素。采用受试者工作特征(ROC)曲线分析胸水CEA对EGFR突变的预测效果。
结果：单次和两次CPBR随后进行细胞块检查后，MPE的累积阳性诊断率分别为80.5%和89.0%，高于CPB（45.7%，54.3%)(P<0.001)。单因素分析显示EGFR突变与胸腔积液和血清CEA相关(P<0.05)。多因素分析显示胸腔积液CEA是预测EGFR突变的独立危险因素(P<0.001)。胸水CEA预测EGFR突变的曲线下面积(AUC)为0.774,高于血清CEA(P=0.043),但与联合检验无差异(P>0.05)。
结论：与CPB相比，CPBR跟着细胞阻滞技巧可显著增长疑似MPE的阳性诊断率。CPBR后胸腔积液CEA检测对肺腺癌MPE患者EGFR突变有较高的预测效果,暗示CPBR后提取胸膜液用于细胞块可能是基因检测的理想标本。
