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

Yıl 2016, Cilt: 30 Sayı: 2, 75 - 80, 01.10.2016

Kemal Can Tertemiz Aylin Özgen Alpaydın Volkan Karaçam Atila Akkoclu

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

• 1. Chinchkar NJ, Talwar D, Jain SK. A stepwise approach to the etiologic diagnosis of pleural effusion in respiratory intensive care unit and short-term evaluation of treatment. Lung India 2015 ; 32(2): 107-15.
• 2. Pyng Lee, Praveen Mathur. Advances in pleural diseases: what is the future for medical thoracoscopy? Curr Opin Pulm Med 2016 May; 22(3): 297-308.
• 3. Maskell NA, Butland RJ; Pleural Diseases Group, Standards of Care Committee, British Thoracic Society. BTS guidelines for the investigation of a unilateral pleural effusion in adults. Thorax 2003; 58(2): 8-17.
• 4. Loddenkemper R. Thoracoscopy: state of the art. Eur Respir J 1998; 11: 213-21.
• 5. Eren Ş, Balcı AE, Ülkü R, Esme H, Eren MN. Plevral Efüzyonlu Olgularda Video Yardımlı Torakoskopik Cerrahi (VATS)’nin Rolü. Tüberküloz ve Toraks Dergisi 2002; 50(1): 53-8.
• 6. Treglia G, Sadeghi R, Annunziata S, et al. Diagnostic performance of fluorine-18- fluorodeoxyglucose positron emission tomography in the assessment of pleural abnormalities in cancer patients: a systematic review and a meta-analysis. Lung Cancer 2014; 83(1): 1-7.
• 7. Müsellim B. Torasentez Ve Plevra Biyopsisi. Solunum 2002 Cilt: 4 Sayı: Ek 1 Sayfa: 107-15.
• 8. Metintaş M. TTD Plevra Bülteni Cilt: 4, Sayı: 3, Eylül 2010.
• 9. Diacon AH, Schuurmans MM, Theron J, et al. Safety and yield of ultrasoundassisted transthoracic biopsy performed by pulmonologists. Respiration 2004; 71: 519–22.
• 10. Tombesi P, Nielsen I, Tassinari D, et al. Transthoracic ultrasonography-guided core needle biopsy of pleural-based lung lesions: prospective randomized comparison between a tru-cut-type needle and a modified Menghini-type needle. Ultraschall Med 2009; 30: 390–5.
• 11. Koegelenberg CF, Bolliger CT, Theron J, et al. Direct comparison of the diagnostic yield of ultrasound-assisted Abrams and Tru-Cut needle biopsies for pleural tuberculosis. Thorax 2010; 65: 857–62.
• 12. Chakrabarti B, Ryland I, Sheard J, et al. The role of Abrams percutaneous pleural biopsy in the investigation of exudative pleural effusions. Chest 2006; 129: 1549-55.
• 13. Mungall IP, Cowen PN, Cooke NT, et al. Multiple pleural biopsy with the Abrams needle. Thorax 1980; 35: 600-2.
• 14. Erasmus JJ, McAdams HP, Rossi SE, et al. FDGPET of pleural effusions in patients with non-small cell lung cancer. Am J Roentgenol 2000; 175: 245–9.
• 15. Gupta NC, Rogers JS, Graeber GM, et al. Clinical role of F-18 fluorodeoxyglucose positron emission tomography imaging in patients with lung cancer and suspected malignant pleural effusion. Chest 2002; 122: 1918–24.
• 16. Schaffler GJ, Wolf G, Schoellnast H, et al. Nonsmall cell lung cancer: evaluation of pleural abnormalities on CT scans with 18F FDGPET. Radiology 2004; 231: 858–65.
• 17. Toaff JS, Metser U, Gottfried M, et al. Differentiation between malignant and benign pleural effusion in patients with extra-pleural primary malignancies: assessment with positron emission tomography-computed tomography. Invest Radiol 2005; 40: 204–9.
• 18. Kim BS, Kim IJ, Kim SJ, et al. Predictive value of F-18 FDG PET/CT for malignant pleural effusion in non-small cell lung cancer patients. Onkologie 2011; 34: 298–303.
• 19. Alkhawaldeh K, Biersack HJ, Henke A, et al. Impact of dual-time-point F-18 FDG PET/CT in the assessment of pleural effusion in patients with non-small-cell lung cancer. Clin Nucl Med 2011; 36: 423–8.
• 20. Letovanec I, Allenbach G, Mihaescu A, et al. 18F-fluorodeoxyglucose PET/CT findings in pleural effusions of patients with known cancer: a cytopathological correlation. Nuklearmedizin 2012; 51: 186–93.