背景:医学胸腔镜检查(MT)并不总是提供胸膜疾病的结论性诊断,因为胸膜疾病的内镜外观可能会产生误导。自体荧光成像(AFI)是一种有效的辅助诊断工具。然而,其在胸膜疾病中的临床应用仍存在争议。
目的:这项前瞻性研究评估了AFI辅助MT诊断恶性胸膜疾病的临床应用价值。
方法:纳入2018年12月至2021年9月期间入住我们诊所的不明原因胸腔积液患者。我们首先进行了白光胸腔镜检查(WLT),然后是AFI,在MT期间。在两种模式下记录内窥镜实时病变的图像。胸膜活检标本进行病理分析。诊断灵敏度的组间差异,特异性,阳性预测值(PPV),使用95%置信区间(CI)评估阴性预测值(NPV)。采用接收器工作特性曲线和决策曲线分析来分析这两种模式的诊断效率。
结果:在126名符合条件的患者中,73例确诊为恶性胸膜病。共检查了492个胸膜部位的1292个活检标本的病理变化。诊断灵敏度,PPV,AFI的NPV为99.7%,58.2%,99.2%,分别。AFI明显优于WLT,灵敏度为79.7%,PPV为50.7%,净现值为62.8%。亚组分析表明,AFIIII型模式对胸膜恶性疾病的特异性明显高于WLT。
结论:AFI可以通过提供更好的可视化来进一步提高MT的诊断效能,便利性,和安全。
Medical thoracoscopy (MT) does not always provide a conclusive diagnosis of pleural diseases because the endoscopic appearance of pleural diseases can be misleading. Autofluorescence imaging (AFI) is an effective assistive diagnostic tool. However, its clinical application for pleural disease remains controversial.
This prospective study evaluated the clinical usefulness of AFI-assisted MT for diagnosis of malignant pleural diseases.
Patients with unexplained pleural effusion admitted to our clinics between December 2018 and September 2021 were enrolled. We performed white-light thoracoscopy (WLT) first, and then AFI, during MT. Images of endoscopic real-time lesions were recorded under both modes. Pleural biopsy specimens were analyzed pathologically. Between-groups differences in diagnostic sensitivity, specificity, positive-predictive value (PPV), and negative-predictive value (NPV) were assessed using 95% confidence intervals (CI). Receiver operating characteristic curves and decision curve analyses were employed to analyze the diagnostic efficiency of these two modes.
Of 126 eligible patients, 73 cases were diagnosed with malignant pleural disease. A total of 1292 biopsy specimens from 492 pleural sites were examined for pathological changes. The diagnostic sensitivity, PPV, and NPV of AFI were 99.7%, 58.2%, and 99.2%, respectively. AFI was significantly superior to WLT, which had a sensitivity of 79.7%, PPV of 50.7%, and NPV of 62.8%. Subgroup analysis showed that the AFI type III pattern was significantly more specific for pleural malignant disease than that of WLT.
AFI could further improve the diagnostic efficacy of MT by providing better visualization, convenience, and safety.