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胸膜 針生檢 (needle biopsy)의 診斷的 價値
石榮觀,朴熙明 慶北大學校 1960 論文集 Vol.4 No.-
The importance of the etiological diagnosis of pleural effusion, particularly differentiating malignant effusion from tuberculous, cannot be overemphasized in clinical medicine. Nevertheless, the conventional diagnostic tools including bacteriological, cytological and roentgenological methods have frequently been of little help in this regard. The introduction of the needle biopsy of the pleura by DeFrancis et al. has certainly cast a light on the solution of this puzzling problem. Several publications on this technic have appeared in the medical literatures, yet the value and pitfall of this newer method have not been fully appreciated. The purpose of this paper is to present the diagnostic value of this method based on 86 biopsies performed on 62 cases with pleural effusion and one case with marked pleural thickening but without effusion. Summary of the results and conclusions are as follows: 1) The specimens obtained were adequate in 49(77. 7%) out of 63 cases and were inade quate in the remaining 14 cases(22.3%). 2) The histological diagnosis of 49 cases in which adequate specimens were obtained included 20 cases of granulomatous pleuritis, 5 malignancy and 24 non·specific pleuritis Of these 49 cases, specific histological diagnosis was made in 25 cases (39.6%), of which 16cases (25.4%) were diagnosed only by biopsy. 3) In 34 cases on whom clinical impression was tuberculosis. 20 cases (39.6%) were diagnosed histologically by biopsy, while only 10 cases (29.4%) were diagnosed bacteriologically. In 13cases, (38.2%) histological diagnosis was established only by biopsy suggesting this group is the best indication for this method. 4) In 13 cases on whom clinical impression was malignancy, only 5 cases (38.2%) were diagnosed by biopsy, and definite diagnosis was also made by conventional methods in 5 cases. However, needle biopsy was still useful in this group as 3 cases were diagnosed only by needle biopsy. 5) In another 16 cases with pleural effusion of various origins, no specific diagnosis was made and needle biopsy was of no value in the etiological diagnosis of empyema. 6) In 86 biopsies, complications such as subcutaneous hematoma and damage of the lung tissue were encountered only twice (2.3%). 7) The needle biopsy of the pleura which is very simple and safe is quite useful in the etiological diagnosis of pleural effusion and should be routinely used in the clinical practice 8) The merit of this method is that it enables rapid and highly accurate diagnosis usually within 48 to 72 hours especially when used together with traditional diagnostic methods.
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