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.	杨婉玲, 付秀华, 顾岩. 恶性胸腔积液的治疗进展. 医学综述, 2017, 23(5): 971-975+980.
2.	朱新程, 王炯. 内科胸腔镜对不明原因胸腔积液诊断价值及恶性胸腔积液镜下表型特征. 临床肺科杂志, 2018, 24(6): 980-983.
3.	郭莹, 鲍文华, 孙涛, 等. 胸腔镜下胸腔积液患者胸膜形态特征及其诊断价值. 医学信息, 2020, 33(9): 182-184.
4.	呙昊尧. 胸腔镜治疗肺癌的研究进展. 中外医学研究, 2022, 20(12): 172-177.
5.	刘宗超, 李哲轩, 张阳, 等. 2020全球癌症统计报告解读. 肿瘤综合治疗电子杂志, 2021, 7(2): 1-14.
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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.	牟向东, 章巍, 柳萍, 等. 内科胸腔镜结合免疫组织化学及电镜技术诊断恶性胸膜间皮瘤一例. 中国呼吸与危重监护杂志, 2015, 14(3): 298-300.
12.	郑礼平, 陈艺丹, 张楠, 等. 血清LDH在EGFR-TKI治疗晚期非小细胞肺癌中的应用价值. 国际肿瘤学杂志, 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.	蒋莉, 周秋曦, 何朗, 等. 血浆LDH与胸腔积液ADA的比值在恶性胸腔积液中的诊断价值. 西部医学, 2018, 30(1): 31-34.
15.	刘文媛, 刘跃建, 高凌云. 良恶性胸腔积液鉴别诊断研究进展. 中国呼吸与危重监护杂志, 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.	袁美荣, 刘群群. ADA, LDH, CEA, CA125, NSE及铁蛋白在结核性胸膜炎与恶性胸腔积液中的鉴别诊断价值. 临床医药实践, 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. 杨婉玲, 付秀华, 顾岩. 恶性胸腔积液的治疗进展. 医学综述, 2017, 23(5): 971-975+980.
2. 朱新程, 王炯. 内科胸腔镜对不明原因胸腔积液诊断价值及恶性胸腔积液镜下表型特征. 临床肺科杂志, 2018, 24(6): 980-983.
3. 郭莹, 鲍文华, 孙涛, 等. 胸腔镜下胸腔积液患者胸膜形态特征及其诊断价值. 医学信息, 2020, 33(9): 182-184.
4. 呙昊尧. 胸腔镜治疗肺癌的研究进展. 中外医学研究, 2022, 20(12): 172-177.
5. 刘宗超, 李哲轩, 张阳, 等. 2020全球癌症统计报告解读. 肿瘤综合治疗电子杂志, 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. 吴国成, 陈焕, 王志国, 等. 内科胸腔镜联合肿瘤标志物在不明原因胸腔积液鉴别诊断的应用. 中国临床医生杂志, 2021, 49(9): 1044-1046.
8. 秦嘉阳, 沈红. 内科胸腔镜在诊疗胸膜疾病中的应用进展. 医学研究生学报, 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. 牟向东, 章巍, 柳萍, 等. 内科胸腔镜结合免疫组织化学及电镜技术诊断恶性胸膜间皮瘤一例. 中国呼吸与危重监护杂志, 2015, 14(3): 298-300.
12. 郑礼平, 陈艺丹, 张楠, 等. 血清LDH在EGFR-TKI治疗晚期非小细胞肺癌中的应用价值. 国际肿瘤学杂志, 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. 蒋莉, 周秋曦, 何朗, 等. 血浆LDH与胸腔积液ADA的比值在恶性胸腔积液中的诊断价值. 西部医学, 2018, 30(1): 31-34.
15. 刘文媛, 刘跃建, 高凌云. 良恶性胸腔积液鉴别诊断研究进展. 中国呼吸与危重监护杂志, 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. 袁美荣, 刘群群. ADA, LDH, CEA, CA125, NSE及铁蛋白在结核性胸膜炎与恶性胸腔积液中的鉴别诊断价值. 临床医药实践, 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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