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目的探讨超声引导下胸膜活检结合二维超声(2DUS)在良恶性胸膜病变诊断中的应用价值。方法回顾性分析193例胸膜病变患者的胸膜活检病理结果、二维超声及临床资料,对比良、恶性胸膜病变的二维超声表现,分析取材成功率及穿刺活检对胸膜良、恶性病变诊断的灵敏度,探讨超声引导下胸膜穿刺活检结合二维超声在胸膜良恶性病变诊断中的应用价值。结果胸膜活检成功率为79.3%(153/193),病理确诊率为84.1%(149/182),其中恶性胸膜病变80.0%,结核性胸膜炎64.8%,胸膜非特异性炎症63.6%。良性组与恶性组胸膜平均厚度分别为(0.61±0.22)cm和(0.74±0.39)cm,两者有统计学意义(P=0.031);良性组与恶性组胸水平均深度分别为(2.95±1.89)cm和(4.42±2.87)cm,两者有统计学意义(P=0.001)。结论良、恶性胸膜病变在2DUS上存在一定的声像学特征,穿刺活检前详细评估其特征可提高胸膜病变超声诊断率和活检阳性率。
Objective To investigate the value of ultrasound-guided pleural biopsy combined with two-dimensional ultrasonography (2DUS) in the diagnosis of benign and malignant pleural diseases. Methods The pleural biopsy results, two-dimensional ultrasonography and clinical data of 193 patients with pleural diseases were retrospectively analyzed. The two-dimensional ultrasonographic findings of benign and malignant pleural diseases were analyzed. The success rate of sampling and the sensitivity of biopsy for the diagnosis of benign and malignant pleural lesions were analyzed , To explore the value of ultrasound guided pleural puncture biopsy combined with two-dimensional ultrasound in the diagnosis of benign and malignant pleural lesions. Results The success rate of pleural biopsy was 79.3% (153/193). The pathological diagnosis rate was 84.1% (149/182), of which malignant pleural disease 80.0%, tuberculous pleuritis 64.8% and non-specific pleural inflammation 63.6%. The average pleural thicknesses in benign group and malignant group were (0.61 ± 0.22) cm and (0.74 ± 0.39) cm respectively, with statistical significance (P = 0.031). The average depth of pleural effusion in benign group and malignant group were (2.95 ± 1.89 ) cm and (4.42 ± 2.87) cm, both of which were statistically significant (P = 0.001). Conclusions There are some features of sonographic features on 2DUS in benign and malignant pleural diseases. The characteristics of the biopsy before biopsy can improve the diagnostic rate of ultrasonography and the positive rate of biopsy.