Investigations on the relationship between nodule manifestation of malignant pleural lesions under medical thoracoscopy and pleural fluid biochemistry and tumor markers_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LV Hang ¹ , WAN Yunyan ¹ , YAO Zhouhong ¹ , SONG Xiaojia ¹ ,  LIN Xinshan ¹ ,  LIN Dianjie ^1,2,3

1. Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250000, P. R. China;
2. Shandong Key Laboratory of Infections Respiratory Disease, Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P. R. China;
3. Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong 250021, P. R. China;

Corresponding?author：

LIN Xinshan, Email: dianjielin@126.com; LIN Dianjie, Email: linxinshan@126.com

Keywords：

Disease of pleura; medical thoracoscopy; biochemical indexes; tumor markers

DOI：

10.7507/1671-6205.202209051

Video：

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Objective To investigate the relationship between the nodule manifestation of malignant pleural lesions under medical thoracoscopy and pleural fluid biochemistry and tumor marker levels. Methods A total of 110 patients with malignant pleura, including 90 cases of lung cancer, 18 cases of malignant mesothelioma, 1 case of diffuse large B-cell lymphoma, and 1 case of ovarian serous carcinoma, who were hospitalized in the Department of Respiratory and Critical Care Medicine, East Hospital of Shandong Provincial Hospital from February 2011 to January 2022 were selected as the study subjects. The pleural nodule manifestation was divided into 6 layers were according to the number of pleural nodules in the medical thoracoscopic field, they were divided into 6 layers: non-nodular group, nodular group (pleural nodules of different sizes were distributed); The nodular group was further divided into nodular scattered group (total number of pleural nodules in all fields under thoracoscopy ≤10) and nodular diffuse group (total number of pleural nodules in all fields under thoracoscopy >10); The nodular diffuse group was further divided into the multiple nodules diffused group (the total number of pleural nodules >10 under thoracoscopy and ≤10 nodules in a single microscopic field) and the nodular diffuse patchwork group (the total number of pleural nodules >10 under thoracoscopy and >10 nodules in a single microscopic field). Four biochemical items of pleural fluid, pleural fluid lactate dehydrogenase (LDH), adenosine deaminase (ADA), glucose (GLU), protein quantification (TP) levels and pleural fluid carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125) levels, serum CEA, and serum cytokeratin fragment 19 (CYFRA21-1) levels were measured to compare the expression levels of indicators between the non-nodular group and the nodular group, the nodular scattered group and the nodular diffuse group, the multiple nodules diffused group and the nodular diffuse patchwork group.Results The LDH level in pleural fluid of nodular group was significantly higher than that of non-nodular group (P<0.01). The LDH level in pleural fluid of diffuse nodular group was higher than that of scattered nodular group (P<0.05). Compared to those in multiple nodules diffused group, the levels of LDH and ADA in pleural fluid of nodules patchy diffused group were significantly increased (P<0.01), and the GLU level was decreased (P<0.05). However, there were no statistically significant differences in the length of disease, smoking index, TP in pleural fluid, CEA in pleural fluid, CA125 in pleural fluid, CEA in serum and CYFRA21-1 in serum between the paired groups.Conclusions There were differences in the expression levels of LDH, ADA and GLU in pleural fluid of different degrees of malignant pleural lesions. The higher the degree of pleural lesions, the higher the levels of LDH and ADA in pleural fluid and the lower the levels of GLU in pleural fluid.

Citation： LV Hang, WAN Yunyan, YAO Zhouhong, SONG Xiaojia, LIN Xinshan, LIN Dianjie. Investigations on the relationship between nodule manifestation of malignant pleural lesions under medical thoracoscopy and pleural fluid biochemistry and tumor markers. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(10): 720-724. doi: 10.7507/1671-6205.202209051 Copy

1.	楊婉玲, 付秀華, 顧巖. 惡性胸腔積液的治療進展. 醫學綜述, 2017, 23(5): 971-975+980.
2.	朱新程, 王炯. 內科胸腔鏡對不明原因胸腔積液診斷價值及惡性胸腔積液鏡下表型特征. 臨床肺科雜志, 2018, 24(6): 980-983.
3.	郭瑩, 鮑文華, 孫濤, 等. 胸腔鏡下胸腔積液患者胸膜形態特征及其診斷價值. 醫學信息, 2020, 33(9): 182-184.
4.	咼昊堯. 胸腔鏡治療肺癌的研究進展. 中外醫學研究, 2022, 20(12): 172-177.
5.	劉宗超, 李哲軒, 張陽, 等. 2020全球癌癥統計報告解讀. 腫瘤綜合治療電子雜志, 2021, 7(2): 1-14.
6.	Lee P, Folch E. Thoracoscopy: advances and increasing role for interventional pulmonologists. Semin Respir Crit Care Med, 2018, 39(6): 693-703.
7.	吳國成, 陳煥, 王志國, 等. 內科胸腔鏡聯合腫瘤標志物在不明原因胸腔積液鑒別診斷的應用. 中國臨床醫生雜志, 2021, 49(9): 1044-1046.
8.	秦嘉陽, 沈紅. 內科胸腔鏡在診療胸膜疾病中的應用進展. 醫學研究生學報, 2022, 35(1): 93-97.
9.	Sinn K, Mosleh B, Hoda MA. Malignant pleural mesothelioma: recent developments. Curr Opin Oncol, 2021, 33(1): 80-86.
10.	Janes SM, Alrifai D, Fennell DA. Perspectives on the treatment of malignant pleural mesothelioma. N Engl J Med, 2021, 385(13): 1207-1218.
11.	牟向東, 章巍, 柳萍, 等. 內科胸腔鏡結合免疫組織化學及電鏡技術診斷惡性胸膜間皮瘤一例. 中國呼吸與危重監護雜志, 2015, 14(3): 298-300.
12.	鄭禮平, 陳藝丹, 張楠, 等. 血清LDH在EGFR-TKI治療晚期非小細胞肺癌中的應用價值. 國際腫瘤學雜志, 2019, 46(6): 337-341.
13.	Pfeiffer T, Schuster S, Bonhoeffer S. Cooperation and competition in the evolution of ATP-producing pathways [published correction appears in Science 2001 Aug 24;293(5534): 1436]. Science, 2001, 292(5516): 504-507.
14.	蔣莉, 周秋曦, 何朗, 等. 血漿LDH與胸腔積液ADA的比值在惡性胸腔積液中的診斷價值. 西部醫學, 2018, 30(1): 31-34.
15.	劉文媛, 劉躍建, 高凌云. 良惡性胸腔積液鑒別診斷研究進展. 中國呼吸與危重監護雜志, 2016, 15(2): 202-205.
16.	Heraud-Farlow JE, Chalk AM, Walkley CR. Defining the functions of adenosine-to-inosine RNA editing through hematology. Curr Opin Hematol, 2019, 26(4): 241-248.
17.	袁美榮, 劉群群. ADA, LDH, CEA, CA125, NSE及鐵蛋白在結核性胸膜炎與惡性胸腔積液中的鑒別診斷價值. 臨床醫藥實踐, 2016, 25(10): 736-738+750.
18.	Pantazopoulos I, Xanthos T, Vlachos I, et al. Pleural fluid glucose: a predictor of unsuccessful pleurodesis in a preselected cohort of patients with malignant pleural effusion. J BUON, 2014, 19(4): 1018-1023.
19.	Good JT Jr, Taryle DA, Sahn SA. The pathogenesis of low glucose, low pH malignant effusions. Am Rev Respir Dis, 1985, 131(5): 737-741.

1. 楊婉玲, 付秀華, 顧巖. 惡性胸腔積液的治療進展. 醫學綜述, 2017, 23(5): 971-975+980.
2. 朱新程, 王炯. 內科胸腔鏡對不明原因胸腔積液診斷價值及惡性胸腔積液鏡下表型特征. 臨床肺科雜志, 2018, 24(6): 980-983.
3. 郭瑩, 鮑文華, 孫濤, 等. 胸腔鏡下胸腔積液患者胸膜形態特征及其診斷價值. 醫學信息, 2020, 33(9): 182-184.
4. 咼昊堯. 胸腔鏡治療肺癌的研究進展. 中外醫學研究, 2022, 20(12): 172-177.
5. 劉宗超, 李哲軒, 張陽, 等. 2020全球癌癥統計報告解讀. 腫瘤綜合治療電子雜志, 2021, 7(2): 1-14.
6. Lee P, Folch E. Thoracoscopy: advances and increasing role for interventional pulmonologists. Semin Respir Crit Care Med, 2018, 39(6): 693-703.
7. 吳國成, 陳煥, 王志國, 等. 內科胸腔鏡聯合腫瘤標志物在不明原因胸腔積液鑒別診斷的應用. 中國臨床醫生雜志, 2021, 49(9): 1044-1046.
8. 秦嘉陽, 沈紅. 內科胸腔鏡在診療胸膜疾病中的應用進展. 醫學研究生學報, 2022, 35(1): 93-97.
9. Sinn K, Mosleh B, Hoda MA. Malignant pleural mesothelioma: recent developments. Curr Opin Oncol, 2021, 33(1): 80-86.
10. Janes SM, Alrifai D, Fennell DA. Perspectives on the treatment of malignant pleural mesothelioma. N Engl J Med, 2021, 385(13): 1207-1218.
11. 牟向東, 章巍, 柳萍, 等. 內科胸腔鏡結合免疫組織化學及電鏡技術診斷惡性胸膜間皮瘤一例. 中國呼吸與危重監護雜志, 2015, 14(3): 298-300.
12. 鄭禮平, 陳藝丹, 張楠, 等. 血清LDH在EGFR-TKI治療晚期非小細胞肺癌中的應用價值. 國際腫瘤學雜志, 2019, 46(6): 337-341.
13. Pfeiffer T, Schuster S, Bonhoeffer S. Cooperation and competition in the evolution of ATP-producing pathways [published correction appears in Science 2001 Aug 24;293(5534): 1436]. Science, 2001, 292(5516): 504-507.
14. 蔣莉, 周秋曦, 何朗, 等. 血漿LDH與胸腔積液ADA的比值在惡性胸腔積液中的診斷價值. 西部醫學, 2018, 30(1): 31-34.
15. 劉文媛, 劉躍建, 高凌云. 良惡性胸腔積液鑒別診斷研究進展. 中國呼吸與危重監護雜志, 2016, 15(2): 202-205.
16. Heraud-Farlow JE, Chalk AM, Walkley CR. Defining the functions of adenosine-to-inosine RNA editing through hematology. Curr Opin Hematol, 2019, 26(4): 241-248.
17. 袁美榮, 劉群群. ADA, LDH, CEA, CA125, NSE及鐵蛋白在結核性胸膜炎與惡性胸腔積液中的鑒別診斷價值. 臨床醫藥實踐, 2016, 25(10): 736-738+750.
18. Pantazopoulos I, Xanthos T, Vlachos I, et al. Pleural fluid glucose: a predictor of unsuccessful pleurodesis in a preselected cohort of patients with malignant pleural effusion. J BUON, 2014, 19(4): 1018-1023.
19. Good JT Jr, Taryle DA, Sahn SA. The pathogenesis of low glucose, low pH malignant effusions. Am Rev Respir Dis, 1985, 131(5): 737-741.

Chinese Journal of Respiratory and Critical Care Medicine

Investigations on the relationship between nodule manifestation of malignant pleural lesions under medical thoracoscopy and pleural fluid biochemistry and tumor markers

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