内科胸腔镜多部位活检联合快速现场评价技术对不明原因胸腔积液的诊断价值

  目的  探讨内科胸腔镜检查中镜下表现及多部位活检结合快速现场评价技术(简称ROSE技术)对不明原因胸腔积液的诊断价值。  方法  回顾性分析解放军第903医院2016年6月—2017年12月因不明原因胸腔积液行内科胸腔镜检查的124例患者的临床资料，通过观察胸腔镜下胸膜变化，术中活检组织的快速现场细胞学表现，并对照最终的病理诊断，对内科胸腔镜检查联合ROSE技术在临床应用中的安全性、有效性及准确性进行系统分析和评价。  结果  124例行胸腔镜检查的患者中良性病变77例，恶性病变41例，诊断不明确者6例。胸腔镜镜下诊断恶性病变的阳性预测值为73.81%，阴性预测值为86.84%，灵敏度为75.60%，特异度为85.71%，与病理诊断符合率为82.2%。胸腔镜联合ROSE技术诊断恶性胸腔积液的阳性预测值为82.98%，阴性预测值为97.18%，灵敏度为95.12%，特异度为89.61%，胸腔镜联合ROSE技术与最终病理结果的一致性较好(Kappa值为0.825，P＜0.001)。  结论  内科胸腔镜在胸腔积液中具有检出率高、准确性高的特点, 而ROSE技术与最终病理结果具有较好的一致性，二者联合进一步提高了不明原因胸腔积液的诊断效率，值得在临床推广应用。 

Diagnostic value of rapid on-site evaluation of biopsy specimens during medical thoracoscopy for undiagnosed pleural effusion

  Objective  This study aims to investigate the diagnostic value of manifestations in medical thoracoscopy and multi-site biopsy combined with rapid on-site evaluation (ROSE) in undiagnosed pleural effusion.  Methods  The clinical data of 124 patients with undiagnosed pleural effusion who underwent medical thoracoscopy from June 2016 to December 2017 in the 903th Hospital of People's Liberation Army were analyzed retrospectively. The safety, effectiveness and accuracy of thoracoscopy combined with ROSE in clinical application were systematically analyzed and evaluated by observing pleural changes under thoracoscope, rapid field cytological manifestations of biopsies during operation and comparing with the final pathological diagnosis.  Results  Among the 124 patients who underwent thoracoscopy, 77 cases were benign, 41 cases were malignant, and 6 cases were uncertain. The positive predictive value was 73.81%, the negative predictive value was 86.84%, the sensitivity was 75.60%, the specificity was 85.71%, and the coincidence rate with pathological diagnosis was 82.2%. The positive predictive value, negative predictive value, sensitivity and specificity were 82.98%, 97.18%, 95.12% and 89.61% in the diagnosis of malignant pleural effusion by thoracoscopy combined with ROSE (Kappa value was 0.825, P < 0.001), respectively.  Conclusion  Medical thoracoscopy have the characteristics of high detection rate and high accuracy in pleural effusion, and ROSE technique have a good consistency with the final pathological results. The combination of the two techniques can further improve the diagnostic efficiency of undiagnosed pleural effusion, which is worthy of clinical application.