A study of the informative value of the histological research of biopsy material for the etiology of pulmonary dissemination

Abstract

Objective — to determine the diagnostic standards according to the criteria — sensitivity (informative), specificity (diagnostic value) and accuracy (effectiveness) of the histological diagnostic method for verifying the etiology of the disseminated processes (DP) of the lungs, depending on the type of surgical intervention.Materials and methods. The results of 216 cases of lung biopsy in 210 patients were analyzed. The patients were divided into groups depending on the method of taking the biopsy material: Group I — 105 (48.6 %) — patients with biopsy material obtained by videothoracoscopy, group ІІ — 38 (17.6 %) — patients in whom the biopsy material was obtained during the video-assisted thoracoscopy with minitatorocotomy; the third group — 9 (4.17 %) — patients in whom the biopsy material was obtained during an open lung biopsy; ІV group — 64 (29.6 %) — persons in whom the biopsy material was obtained by transbronchial biopsy of the lungs.Results and discussion. When determining the level of accuracy of the methods, a high level was established for histological examination in cases of videothoracoscopy, video-assisted thoracoscopy and open lung biopsy — 100.0 %, respectively. In the transbronchial lung biopsy, the precision and specificity of the method was 66.7 % and 80.0 % respectively, and the effectiveness of 57.0 %, due to the presence of false negative, mistakenly positive and non-informative biopsy results (a total of 50.0 %). When performing videothoracoscopy, video-assisted thoracoscopy and open lung biopsy in cases of tuberculous lung injury, the efficacy was 100 %. When using transbronchial biopsy 43 %. When performing an open biopsy, lung efficacy was 100 % in cases of metastatic lung injury. The indicator of the videoassociated thoracoscopy method was 75 %. In cases of mycotic lesion and non-specific respiratory diseases, all methods of pulmonary biopsy showed 100.0 % of diagnostic standards. Among the general contingent of patients on admission to the clinic, patients with a diagnosis of «disseminated process in the lungs of unidentified etiology» prevailed — 121 ((57.6 ± 3.4) %) of patients and «disseminated process in the lungs in combination with intrathoracic lymphadenopathy syndrome» — 41 ((19.5 ± 2.7) %) of patients. After conducting a biopsy with subsequent histological examination, sarcoidosis was most commonly encountered in 81 ((37.5 ± 3.3) %) cases and metastatic lung injury was 36 ((16.7 ± 2.5) %). High indexes of sensitivity and specificity of histological research in the use of videothoracoscopy and videoassociated thoracoccopy have been established in determining the etiology of the disseminated process in the lungs of unidentified etiology, the range (75.0—100.0 %). Indicators of general accuracy of the histological method in the use of video-assisted thoracoscopy and videotacoscopy were approximately the same — 94.7 and 95.2 % respectively.Conducting an open lung biopsy made it possible to ensure a 100.0 % verification of the diagnosis with the diagnosis of «disseminated process in the lungs of unidentified etiology,» but this method is quite complicated and dangerous, first of all for the patient.The use of TBLB for the diagnosis of pulmonary dissemination is considered the safest, but the least effective method, the accuracy index in the histological study method was 65.6 %.Conclusions. As a result of the study and analysis of the data obtained, we can conclude that the majority of patients hospitalized in our clinic were patients with a diagnosis of «disseminated process in the lungs of unidentified etiology» and «disseminated process in the lungs in combination with intracranial lymphadenopathy syndrome».After the histological examination, «sarcoidosis» and metastatic lung lesions were most commonly encountered. When applying videothoracoscopy and videoassociated thoracoscopy, high sensitivity and specificity parameters of the histological examination were established — range 75.0—100.0 %. An open lung biopsy made it possible to provide 100.0 % verification of the diagnosis with the diagnosis of «disseminated process in the lungs of unidentified etiology». Transbronchial biopsy in dissemination is considered to be the safest but least informative method (the accuracy index in the histological study was 65.6 %).