ObjectiveTo compare the accuracy and safety of semirigid thoracoscopy and rigid thoracoscopy in the diagnosis of unexplained pleural effusion. MethodsA prospective randomized study was conducted, in which the patients with unexplained pleural effusion were enrolled consecutively from March 2012 to March 2014 in West China Hospital. The age of the patients ranged from 18 to 75 years. After informed consent, the subjects were randomized to a semirigid thoracoscopy group or a rigid thoracoscopy group to be examined. ResultsForty-nine patients were assigned to the semirigid thoracoscopy group, and 48 patients were assigned to the rigid thoracoscopy group. After thoracoscopy procedure, 44 patients were confirmed as malignant diseases, and 48 patients were confirmed as benign diseases. The overall diagnostic accuracy was 93.9% for the semirigid procedure and 95.8% for the rigid procedure. The diagnostic sensitivity and specificity for malignancy were 96.0% and 100.0% for the semirigid thoracoscopy, and 95.2% and 100.0% for the rigid thoracoscopy, respectively, without statistical significant differences between two groups. All the patients tolerated well with minor complications after two kinds of thoracoscopy. ConclusionsThe diagnostic accuracy of semirigid thoracoscopy and rigid thoracoscopy is comparable in the diagnosis of unexplained pleural diseases. The samples obtained by semirigid thoracoscopy are smaller, but adequate for pathological examination.
ObjectiveTo investigate whether liquid-based cytology (LBC) can improve diagnostic value of cytological assessment of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). MethodsA cohort of 600 cases who underwent EBUS-TBNA from June 2012 to September 2013 was enrolled in this prospective study in West China Hospital. EBUS-TBNA was carried out under local anesthesia and moderate sedation. The procedure was performed with echobronchoscopes. Histological tissues were stained with hematoxylin and eosin for further study. Additional immunohistological analysis was performed for establishing a reliable diagnosis as necessary. Aspirates were smeared on glass slides and separate aspirates were processed by the monolayer SurePath method. ResultsIn total, 480 cases of malignant tumors and 120 cases of benign lesions were confirmed by histological examination. The sensitivity of SurePath liquid-based preparations and conventional smears was 82.1% and 56.0%, and the specificity was 87.5% and 82.5%, respectively. The combined specificity was 100.0%. The positive predictive value of two methods combined was 96.3% and 92.8%, whereas the negative predictive value was 54.9% and 31.9%, respectively. The difference between the two methods was significant (P < 0.05). ConclusionsLBC preparation can improve cytological assessment of EBUS-TBNA. Histological study is necessary when the cytological diagnosis is obscure.