MALİGN PLEVRAL HASTALIKLARDA KAPALI PLEVRA BİYOPSİSİ VE PET/CT'NİN TANISAL DEĞERİ

Öz

Amaç: Bu çalışmada malign plevral efüzyon ön tanısı olan olgularda kapalı plevra biyopsisinin tanıya olan katkısını ve PET/CT nin malign-benign ayrımındaki rolünü ortaya koymayı amaçladık. Yöntem ve Gereç: Çalışmaya eksudatif plevral efüzyonu olan ve sitolojik inceleme ile tanıya ulaşılamayan ve ikinci tanısal basamak olarak kapalı plevra biyopsisi yapılan olgular dahil edildi. Olguların klinik özellikleri, PET/CT ve patolojik sonuçları retrospektif olarak değerlendirildi. Bu olgulardan tanısal amaçlı VATS uygulanan olgularda kapalı plevra biyopsisi ile olan tanısal korelasyonu araştırıldı. Bulgular: Toplam 98 hasta çalışmaya dahil edildi. Kapalı plevra biyopsisi sonucunda 62 (%63.2) hastada benign, 24 (%25.9) hastada malign ve 12 (%12.9) hastada ise yetersiz patolojik sonuç saptandı. Kapalı plevra biyopsisinin sensitivitesi %16, spesifitesi %100, pozitif prediktif değeri %100, negatif prediktif değeri %52.2 ve tanısal geçerliliği %56.2 saptandı. PET-CT de plevral tutulum olmayan 16 hastanın 7‘sinde malignite tanı saptandı. Buna göre PET/CT'nin sensitivitesi %78.7, spesifitesi %56.2, pozitif prediktif değeri %78.7, negatif prediktif değeri %56.2 ve tanısal geçerliliği %71.4 saptandı. Sonuç: Plevral effüzyon tanısında kapalı plevra biyopsisinin tanısal değerinin malign patolojilerde düşük olması nedeni ile torakoskopik cerrahi biyopsiler ön planda düşünülmelidir. Genel durumu bozuk olan olgularda kapalı plevra biyopsisi ilk basamak tetkik olarak kullanılabilir ancak sensitivitesinin oldukça düşük olduğu göz önünde bulundurulmalıdır. Özellikle akciğer dışı malignitesi olan olgularda PET/CT'nin plevral tutulumu göstermede negatif prediktif değerinin düşük olması nedeni ile PET/CT tutulumu olmayan olgularda da ileri tanısal cerrahi işlemler yapılmalıdır.

Anahtar Kelimeler

• Malign plevral efüzyon, kapalı plevra biyopsisi, VATS, PET/CT

DIAGNOSTIC VALUE OF BLIND PLEURAL BIOPSY AND PET/CT IN MALIGNANT PLEURAL DISEASES

Öz

Aim: In this study we aimed to find out diagnostic value of blinded pleural biopsy and the role of PET/CT for distinction malingant or benign in patients with suspected malignant pleural effusion. Material and Methods: Blinded pleural biopsy performed cases who are not able to diagnosed with cytologic examination with exudative pleural effusion are included to the study. Clinical properties, PET/CT and pathological results of the cases are analysed retrospectively. Diagnostic correlation of blinded pleural biopsy is evaluated in VATS biopsy performed cases. Results: Ninty-eight cases are included to the study. As the results of blinded pleural biopsy; 62(63.2%) patients were diagnosed as benign, 24(25.9%) patients diagnosed as malignant, and 12(12.9%) patients as non-diagnostic sample. The sensitivity was 16%, spesifity was 100%, positive predicted value was 100%, negative predictive value was 52.2% and diagnostic accuracy was 56.2% for the blinded pleural biopsy. Malingancy was detected in 7 cases of PET/CT negative 16 cases. According to this findings the sensitivity was 78.7%, spesifity was 56.2%, positive predicted value was 78.7%, negative predictive value was 56.2% and diagnostic accuracy was 71.4% for PET/CT. Conclusion: According to low diagnostic value of the blinded pleural biopsy in malignant pleural effusions thoracoscopic surgical biopsy should be performed as a first line diagnostic procedure in these cases. Blinded pleural biopsy should be used in cases with low clinical status cases and has in mind the low diagnostic sensitivity. PET/CT has low negative predictive value especialy in cases with extrathorasic malignancies for pleural invasion. So surgical biopsies should be performed also PET/CT negative cases.

Anahtar Kelimeler

• Malignant pleural effusion, Blinded pleural biopsy, VATS, PET/CT

Kaynakça

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