可曲式内科胸腔镜细胞学快速现场评估联合血清肿瘤标志物对胸腔积液病因良恶性诊断的价值  

Value of rapid field evaluation of cytology by flexible medical thoracoscopy combined with serum tumor markers in the malignant and benign diagnosis of unexplained pleural effusion

作　　者：苟冶然 徐治波[1] 林家晨 文艳梅[1] 邓正旭[1] Gou Yeran;Xu Zhibo;Lin Jiachen;Wen Yanmei;Deng Zhengxu(Department of Respiratory and Critical Care Medicine,Chengdu Second People's Hospital,Chengdu 610017,China)

机构地区：[1]成都市第二人民医院呼吸与危重症医学科,成都610017

出　　处：《肿瘤研究与临床》2024年第4期285-289,共5页Cancer Research and Clinic

摘　　要：目的探讨可曲式内科胸腔镜细胞学快速现场评估联合血清肿瘤标志物对不明病因胸腔积液病因良恶性的诊断价值。方法回顾性病例系列研究。回顾性收集2020年3月至2022年3月成都市第二人民医院收治的147例不明病因胸腔积液患者的临床资料。患者均于胸腔镜下取患者病变组织标本,行可曲式内科胸腔镜病变组织细胞学快速现场评估,并送病理检查;测定血清细胞角蛋白片段抗原21-1、癌胚抗原、特异性神经元烯醇化酶、鳞状细胞癌抗原水平。采用Kappa检验评定可曲式内科胸腔镜细胞学快速现场评估、血清肿瘤标志物单独及二者联合诊断与病理诊断胸腔积液病因的一致性;以病理诊断为金标准,计算各方法对胸腔积液病因诊断效能。结果病理诊断结果显示,147例患者中,胸腔积液病因恶性62例(42.2%),包括腺癌56例、鳞状细胞癌3例、间皮瘤2例、小细胞肺癌1例;良性85例(57.8%),包括结核性胸膜炎75例、炎性胸腔积液9例、化脓性胸膜炎1例。可曲式内科胸腔镜细胞学快速现场评估诊断胸腔积液病因恶性64例(43.5%),良性83例(56.5%);其中,53例(36.1%)恶性与病理诊断一致,74例(50.3%)良性与病理诊断一致;2种诊断方法的一致性一般(Kappa=0.722,P<0.001)。血清肿瘤标志物检查诊断胸腔积液病因恶性66例(44.9%),良性81例(55.1%);其中,50例(34.0%)恶性与病理诊断一致,69例(46.9%)良性与病理诊断一致;两种诊断方法的一致性一般(Kappa=0.613,P<0.001)。可曲式内科胸腔镜细胞学快速现场评估联合血清肿瘤标志物诊断胸腔积液病因恶性63例(42.9%),良性84例(57.1%);其中,58例(39.5%)恶性与病理诊断一致,80例(54.4%)良性与病理诊断一致;两种诊断方法的一致性较好(Kappa=0.875,P<0.001)。可曲式内科胸腔镜细胞学快速现场评估联合血清肿瘤标志物诊断不明原因胸腔积液病因的灵敏度、特异度、约登指数分别为93.5%(58/62)�Objective To explore the diagnostic value of rapid field evaluation of cytology by flexible medical thoracoscopy combined with serum tumor markers in the malignant and benign diagnosis of unexplained pleural effusion.Methods A retrospective case series study was conducted.The clinical data of 147 patients with unexplained pleural effusion admitted to the Chengdu Second People's Hospital from March 2020 to March 2022 were retrospectively collected.Samples of lesion tissues were obtained under thoracoscopy,and all patients underwent rapid field evaluation of cytology by flexible medical thoracoscopy and pathological examination was performed.The serum cytokeratin 19 fragment(CYFRA21-1),carcinoembryonic antigen(CEA),specific neuron enolase(NSE),squamous cell carcinoma antigen(SCC-Ag)levels were measured.The consistency between rapid field evaluation of cytology by flexible medical thoracoscopy alone,serum tumor markers alone,the combinayion of both and the cause of pleural effusion diagnosed with pathology was evaluated by using Kappa test.The pathological diagnosis was taken as the gold standard.Efficacy of the above methods in the etiological diagnosis of pleural effusion were calculated.Results The pathological diagnosis results showed that among 147 patients with pleural effusion of unknown cause,there were 62(42.2%)malignant patients,including 56 cases of adenocarcinoma,3 cases of squamous cell carcinoma,2 cases of mesothelioma,and 1 case of small cell lung cancer;85 cases(57.8%)were benign patients,including 75 cases of tuberculous pleurisy,9 cases of inflammatory pleural effusion,and 1 case of purulent pleurisy.The results of rapid field evaluation of cytology by flexible medical thoracoscopy in the diagnosis of pleural effusion showed that 64 cases(43.5%)were malignant and 83 cases(56.5%)were benign,among which 53 malignant cases(36.1%)were consistent with pathological diagnosis,74 benign cases(50.3%)were consistent with pathological diagnosis;and the consistency of the two diagnostic methods was general(Kap

关 键 词：胸腔积液 活组织检查 胸腔镜检查 生物学标记 肿瘤 诊断 

分 类 号：R730.43[医药卫生—肿瘤]