关键词: 胸腔镜检查, 冷冻, 活组织检查, 结核, 胸膜, 对比研究

Abstract:

Objective: To evaluate the diagnostic value of cryobiopsy in patients with suspected tuberculous pleurisy by comparing cryobiopsy and biopsy forceps biopsy. Methods: A prospective study was conducted. A total of 73 patients with suspected tuberculous pleurisy were consecutively included in Harbin Chest Hospital from May 2022 to August 2024 in accordance with the enrollment criteria. All enrolled patients underwent internal medicine thoracoscopic biopsy forceps biopsy and cryobiopsy simultaneously. Both the biopsy tissue and pleural effusion were tested by GeneXpert MTB/RIF, Mycobacterium tuberculosis resistance gene-on-chip method (referred to as “drug resistance gene-on-chip method”), and Mycobacterium tuberculosis BACTEC MGIT 960 (referred to as “MGIT 960”) culture and pathological examination. Based on the final clinical diagnosis results, the differences in tissue specimen diameter, pathological positive rate, etiological positive rate, complications and other indicators of biopsy forceps biopsy and cryobiopsy were compared, and the diagnostic value of internal thoracoscopic cryobiopsy for patients with suspected tuberculous pleurisy was evaluated. Results: All 73 patients obtained a definitive diagnosis. Among them, 64 patients (87.7%, 64/73) achieved a definitive diagnosis by biopsy forceps biopsy, while 71 patients (97.3%, 71/73) did so by cryobiopsy. A total of 60 cases (82.2%, 60/73) were diagnosed with tuberculous pleurisy, including 43 cases (58.9%, 43/73) of drug sensitive tuberculous pleurisy and 17 cases (23.3%, 17/73) of drug-resistant tuberculous pleurisy (including 3 cases of monodrug-resistant, 8 cases of multidrug-resistant, 1 case of polydrug-resistant, 2 cases of pre-extensively drug-resistant, and 3 cases of extensively drug-resistant). The remaining 13 cases (17.8%, 13/73) were diagnosed with pleural effusion due to other causes, including 6 cases (8.2%, 6/73) of malignant pleural mesothelioma, 2 cases (2.7%, 2/73) of adenocarcinoma, 1 case (1.4%, 1/73) of squamous cell carcinoma, 1 case (1.4%, 1/73) of small cell neuroendocrine carcinoma, 2 cases (2.7%, 2/73) of inflammation, and 1 case (1.4%, 1/73) of amyloidosis. The diameter of the tissue specimen of cryobiopsy ((7.47±0.71) mm) was significantly larger than that of biopsy forceps biopsy ((2.34±0.22) mm), and the histopathological positivity rate of cryobiopsy (97.3%, 71/73) was significantly higher than that of biopsy forceps biopsy (87.7%, 64/73); the differences were statistically significant (t=58.820, P<0.001; χ²=4.818, P=0.028). The histopathogenic positivity rate of cryobiopsy (GeneXpert MTB/RIF: 91.7%, 55/60; resistance gene chip examination: 61.7%, 37/60; MGIT 960 culture: 73.3%, 44/60) was significantly higher than those of biopsy clamp biopsy (GeneXpert MTB/RIF was 70.0% (42/60), drug resistance gene microarray was 28.3% (17/60), MGIT 960 culture was 40.0% (24/60)), and the differences were statistically significant (χ²=8.015, P=0.005; χ²=13.470, P<0.001; χ²=13.570, P<0.001). The diagnostic sensitivity of cryobiopsy for tuberculosis pleurisy (98.5%, 66/67) was significantly higher than that of biopsy forceps biopsy (88.9%, 56/63), and the difference was statistically significant (χ²=5.202, P=0.023). No serious adverse reactions occurred postoperatively in either biopsy methods. A total of 16 cases (21.9%, 16/73) developed mild chest pain, among which the incidence of chest pain in cryobiopsy (5.5% (4/73)) was lower than that in biopsy (16.4%, 12/73), and the difference was statistically significant (χ²=4.492, P=0.034). Conclusion: Internal thoracoscopic cryobiopsy has high diagnostic sensitivity and the advantage of high safety for patients with suspected tuberculous pleurisy, and can further improve the precise treatment level of tuberculous pleurisy through drug susceptibility testing.

Key words: Thoracoscopy, Freezing, Biopsy, Tuberculosis, pleural, Comparative study