背景:图像引导或辅助的针活检以及越来越多的医疗胸腔镜(MT)的使用显着提高了胸膜疾病的诊断准确性。然而,对于哪些患者应接受内科胸腔镜检查(MT),哪些患者应接受影像引导或辅助穿刺活检作为第一程序,以确保胸腔积液患者的更高诊断准确性,目前尚无共识.
目的:哪种活检方法更适合诊断胸腔积液的患者?
方法:本前瞻性,随机化,平行研究包括二百二十八例未确诊的渗出性胸腔积液患者。根据计算机断层扫描(CT)发现将患者分为两组。第1组:仅有胸腔积液的患者;第2组:有胸膜增厚或病变伴胸腔积液的患者。每组患者被随机分配到影像辅助艾布拉姆斯穿刺活检(IA-ANPB)或MT组。诊断灵敏度,可靠性,并确定两组的安全性.
结果:在第1组中,IA-ANPB臂的假阴性率为30.3%,MT臂的假阴性率为3.1%。在第2组中,IA-ANPB的比率为11.9%,MT的比率为4.7%。在第1组中,IA-ANPB臂的灵敏度为69.7%,负似然比0.30。MT组的相同比率为96.9%和0.03(p=0.009)。在第2组中,IA-ANPB臂的这些值分别为88.1%和0.12,MT臂的这些值分别为95.4%和0.05(p=0.207)。两种活检方法之间的并发症发生率没有差异(8.5%和15.8%,分别为;p=0.107)。
结论:MT在所有胸腔积液患者中显示出较高的诊断成功率。另一方面,IA-ANPB在胸腔积液和相关的胸膜增厚/病变患者中显示出与MT相似的诊断成功率。因此,在后一种情况下,IA-ANPB在MT之前可能是优选的。
BACKGROUND: Image-guided or assisted needle biopsies and the increasing use of medical thoracoscopy (MT) have increased the diagnostic accuracy of pleural diseases significantly. However, no consensus exists regarding which patients with pleural effusion should undergo MT and which patients should undergo image-guided or assisted needle biopsy as the first procedure to ensure greater diagnostic accuracy.
OBJECTIVE: Which biopsy method is more appropriate for which patient to provide the highest diagnostic accuracy in the diagnosis of pleural effusion?
METHODS: This prospective, randomized, parallel study included 228 patients with undiagnosed exudative pleural effusion. Patients were divided into two groups based on CT scan findings. Group 1 included patients with pleural effusion only. Group 2 included patients with pleural thickening or lesion in addition to pleural effusion. Patients in each group were assigned randomly to an image-assisted Abrams needle pleural biopsy (IA-ANPB) or MT arm. The diagnostic sensitivity, reliability, and safety were determined for both groups.
RESULTS: The false-negative rate was 30.3% for the IA-ANPB arm and 3.1% for the MT arm in group 1. The same rates were 11.9% for IA-ANPB and 4.7% for MT in group 2. In group 1, the sensitivity for the IA-ANPB arm was 69.7%, and the negative likelihood ratio was 0.30. The same rates for the MT arm were 96.9% and 0.03 (P = .009). In group 2, these values were 88.1% and 0.12 for the IA-ANPB arm and 95.4% and 0.05 for the MT arm (P = .207). The rate of complications between the two biopsy methods was not different (8.5% and 15.8%, respectively; P = .107).
CONCLUSIONS: MT showed a high diagnostic success in all patients with pleural fluid. However, IA-ANPB showed similar diagnostic success as MT in patients with pleural effusion and associated pleural thickening or lesions. Therefore, in the latter case, IA-ANPB could be preferable to MT.
BACKGROUND: ClinicalTrials.gov; No.: NCT05428891; URL: www.
RESULTS: gov.