Diagnostisches Vorgehen beim Pleuraerguss

 

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Zusammenfassung

Der Pleuraerguss ist ein häufiges pneumologisches und interdisziplinäres Problem. In Verbindung mit bildgebenden Basisuntersuchungen bleibt die Ergussprobepunktion zur Transsudat/Exsudat-Diskriminierung der Grundbaustein der Ergussdiagnostik. Die klassischen Light'schen Kriterien, bestehend aus Eiweiß und LDH (beziehungsweise ihr Serumwert-Ratio) erweisen sich hierbei mit einer Genauigkeit von 95 % am zuverlässigsten. Die Ergänzung um das Cholesterin zum Tripletttest kann in Einzelfällen zur verbesserten Identifikation der Transsudate genutzt werden. In der Regel lösen nur Exsudate als Hinweis auf direkte pleurale Krankheitsbeteiligung weiteren lokalen Klärungsbedarf aus. Die bakterielle Pleuritis, der maligne Erguss und die tuberkulöse Pleuritis sind die wichtigsten Differenzialdiagnosen. Die Thorakozentese ermöglicht mit einer Vielzahl biochemischer, zytologisch-immunologischer, mikrobiologischer und zunehmend auch innovativer zellbiologischer Marker in ca. 70 % (- 90 %) eine Diagnose oder wesentliche Einengung der Diagnose. Bei der bakteriellen Pleuritis ist die Thorakozentese in Bezug auf lokale Interventionen unmittelbar therapierelevant. Sie liefert ferner eine Plattform für weiterführende bildgebungs- oder endoskopie-gestützte bioptische Untersuchungen, in deren Mittelpunkt die internistische Thorakoskopie (Pleuroskopie) steht. Die ungezielte Stanz- oder Nadelbiopsie ist gleichermaßen bei entzündlichen wie malignen Erkrankungen zu 40 - 70 % diagnostisch, thorakoskopisch lässt sich der exsudative Pleuraerguss zu 95 % klären. Maligne Ergüsse können so in Kombination mit den weniger invasiven Untersuchungen zu 97 % spezifisch diagnostiziert werden, tuberkulöse Ergüsse zu nahezu 100 %. Zusätzliche interventionelle Möglichkeiten im Sinne der vollständigen Drainage ± Pleurodese (Talkpoudrage), ggf. auch Lösung von Kammerung und Verklebung ± Fibrinolyse charakterisieren die Thorakoskopie bei Durchführung in Lokalanästhesie auf hohem Sicherheitsniveau auch gegenüber wesentlich aufwendigeren chirurgischen Techniken als Goldstandard im Management der Pleuraergüsse.

Abstract

Pleural effusion is a common pneumologic and interdisciplinary problem. Transudate/exsudate discrimination of the pleural fluid by thoracentesis remains the diagnostic basic algorithm. Regardless of a number of new markers, classical LIGHT's criteria comprising the pleural fluid protein- and LDH-values (or their serum ratio respectively) reveal the highest potency with an overall accuracy of 95 %. Expansion to cholesterol-determination (triplet test) may be helpful to identify transudates in indeterminate cases. The need for further local diagnostic evaluation is then usually restricted to exudates. Bacterial pleurisy, malignant and tuberculous effusion are the principal differential diagnoses. With the use of a variety of conventional biochemical, cytologic, immunologic and microbiologic investigations, thoracentesis will allow- or substantially narrow-diagnosis of exudates in about 70 %, with novel cell biological markers in some conditions up to 90 %. In bacterial pleurisy thoracentesis provides information directly relevant to management in terms of local interventions. It also constitutes a platform for more invasive imaging- or endoscopy-guided investigations with a focus on medical thoracoscopy (pleuroscopy). Blind needle biopsy is diagnostic in a range of 40 - 70 % both in malignancy and inflammatory disease, thoracoscopy may clarify exudative conditions in about 95 %. Thus malignancy may be specifically diagnosed in 97 % of cases, tuberculous effusion in virtually 100 %. The value of thoracoscopy is augmented by interventional options including complete evacuation of the pleural cavity, eventually followed by talc pleurodesis (“poudrage”) in recurrent effusions or adhesiolysis, irrigation and fibrinolysis protocols in certain inflammatory conditions. These combined features as accomplished in local anesthesia on a remarkably high safety level characterise medical thoracoscopy as a gold standard tool for the management of pleural disease even in comparison to more elaborate surgical procedures.

Literatur

• 1 Antony V B. Pleural disease.  Semin Respir Crit Care Med. 1995;  4 259-260
  Article in Thieme ConnectPubMedGoogle Scholar
• 2 Light R W. Thoracentesis (diagnostic and therapeutic) and pleural biopsy. In: Light RW. Pleural Diseases, Fourth Edition. Baltimore: Williams and Wilkins 2001
  Article in Thieme ConnectPubMedGoogle Scholar
• 3 Marel M. Epidemiology of pleural effusion. In: Loddenkemper R, Antony VB (Hrsg.). Pleural Diseases. Eur Respir Mon 2002 7 (22): 146-158
  Article in Thieme ConnectPubMedGoogle Scholar
• 4 Zocchi L. Physiology and pathophysiology of pleural fluid turnover. In: Loddenkemper R, Antony VB (Hrsg.). Pleural Diseases. Eur Respir Mon 2002 7 (22): 28-49
  Google Scholar
• 5 Sahn S A. The diagnostic value of pleural fluid analysis.  Seminars Resp Crit Care Med. 1995;  16/4 269-278
  PubMedGoogle Scholar
• 6 Bittner R C. Bildgebende Diagnostik bei Pleuraerkrankungen.  Pneumologie. 2004;  58 238-254
  Article in Thieme ConnectPubMedGoogle Scholar
• 7 NHLBI-levels of evidence and grades of recommendation. Oxford Centre for Evidence Based Medicine. http: //www.cbm.net/levels_of-evidence.asp 2001
  Google Scholar
• 8 Light R W. Diagnostic principles in pleural disease.  Eur Respir J. 1997;  10 476-481
  CrossrefPubMedGoogle Scholar
• 9 Colt H G, Mathur P N. Thoracentesis. In: Colt HG, Mathur PN (eds.). Manual of pleural procedures. Lippincott: Williams & Wilkins 1999: 93-103
  Google Scholar
• 10 Kalomenidis I, Rodriguez M, Barnette R. et al . Patient with bilateral pleural effusion. Are the findings the same in each fluid?.  Chest. 2003;  124 167-76
  CrossrefPubMedGoogle Scholar
• 11 Collins T R, Sahn S A. Thoracentesis: Complications, patients experience and diagnostic value.  Chest. 1987;  91 817-822
  CrossrefPubMedGoogle Scholar
• 12 Burgess L J, Maritz F J, Taljaard F FJ. Comparative analysis of the biochemical parameters used to distinguish between pleural transudates and exudates.  Chest. 1995;  107 1604-1609
  CrossrefPubMedGoogle Scholar
• 13 Romero S, Candela A, Martin C. et al . Evaluation of different criteria for the separation of pleural transudates from exudates.  Chest. 1993;  104 399-404
  CrossrefPubMedGoogle Scholar
• 14 Romero-Candeira S, Hernandez L, Romero-Brufao S. et al . Is it meaningful to use biochemical parameters to discriminate between transudative and exudative pleural effusions?.  Chest. 2002;  122 1524-1529
  CrossrefPubMedGoogle Scholar
• 15 Heffner J E, Brown L K, Barbieri C A. Diagnostic value of tests that discriminate between exudative and transudative pleural effusions.  Chest. 1997;  111 970-980
  PubMedGoogle Scholar
• 16 Heffner J E, Highland K, Brown L K. A meta-analysis derivation of continuous likelihood ratios for diagnosing pleural fluid exudates.  Am J Respir Crit Care Med. 2003;  167 1591-1599
  CrossrefPubMedGoogle Scholar
• 17 Eid A A, Keddissi J I, Samaha M. et al . Exudative effusions in congestive heart failure.  Chest. 2002;  122 1518-1523
  CrossrefPubMedGoogle Scholar
• 18 Light R W, Girard M, Jenkinson G. et al . Parapneumonic effusions.  Am J Med. 1980;  69 507-512
  CrossrefPubMedGoogle Scholar
• 19 Potts D E, Levin D C, Sahn S A. Pleural fluid pH in parapneumonic effusion.  Chest. 1976;  70 328-331
  PubMedGoogle Scholar
• 20 Poe R H, Marin M G, Israel R H. et al . Utility of pleural fluid analysis in predicting tube thoracostomy/decortication in parapneumonic effusions.  Chest. 1991;  100 963-967
  PubMedGoogle Scholar
• 21 Heffner J E, Brown L K, Barbieri C. et al . Pleural fluid chemical analysis in parapneumonic effusions: a meta-analysis.  Am J Respir Crit Care Med. 1995;  151 1700-1708
  CrossrefPubMedGoogle Scholar
• 22 Davies C WH, Gleeson F V, Davies R JO. BTS guidelines for the management of pleural infection.  Thorax. 2003;  58: Suppl II 18-28
  PubMedGoogle Scholar
• 23 Colice G L, Curtis A, Deslaurier J. et al . Medical and surgical treatment of parapneumonic effusion. An ACCP evidence-based guideline.  Chest. 2000;  18 1158-1171
  PubMedGoogle Scholar
• 24 Alfagame I, Munoz F, Pena N. et al . Empyema of the thorax in adults: etiology, microbiologic findings and management.  Chest. 1993;  103 839-843
  CrossrefPubMedGoogle Scholar
• 25 Herziger D, Gogolin J, Frank W. Ergebnisse der internistischen Empyemtherapie.  Pneumologie. 2003;  57 S23
  PubMedGoogle Scholar
• 26 Adelman M, Albeda S M, Gottlieb J. et al . Diagnostic utility of pleural fluid eosinophilia.  Am J Med. 1984;  77 915-920
  CrossrefPubMedGoogle Scholar
• 27 Martinez-Garcia M A, Cases Viedma E, Perpina Tordera M. et al . Repeated thoracentesis: an important risk factor for eosinophilic pleural effusion?.  Respiration. 2003;  70 82-86
  CrossrefPubMedGoogle Scholar
• 28 Ferrer J. Tuberculous pleural effusion and tuberculous empyema.  Sem Respir Crit Care Med. 2001;  6/22 637-646
  PubMedGoogle Scholar
• 29 Epstein D M, Kline L R, Albeda S M. et al . Tuberculous pleural effusions.  Chest. 1987;  91 106-109
  PubMedGoogle Scholar
• 30 Maartens G, Bateman E D. Tuberculous pleural effusion: increased culture yield with bedside inoculation of pleural fluid and poor diagnostic value of adenosine deaminase.  Thorax. 1991;  46 96-99
  PubMedGoogle Scholar
• 31 Valdes L, Alvarez D, SanJose E. et al . Value of adenosine deaminase in the diagnosis of tuberculous pleural effusions in young patients in a region of high prevalence of tuberculosis.  Thorax. 1995;  50 600-603
  PubMedGoogle Scholar
• 32 Ungerer J PJ, Oosthuizen H M, Retief J H. Significance of adenosine deaminase activity and its isoenzymes in tuberculous effusions.  Chest. 1994;  106 33-37
  CrossrefPubMedGoogle Scholar
• 33 Riantawan P, Chaowalit P, Wongsangiem M. et al . Diagnostic value of pleural adenosine deaminase in tuberculous pleuritis with reference to HIV infection and a Bayesian analysis.  Chest. 1999;  116 97-103
  CrossrefPubMedGoogle Scholar
• 34 Söderblom T, Nyberg P, Teppo A M. et al . Pleural fluid interferon-γ and tumour necrosis factor-α in tuberculous and rheumatoid pleurisy.  Eur Respir J. 1996;  9 1652-1658
  CrossrefPubMedGoogle Scholar
• 35 Ogawa K, Koga H, Hirakata Y. et al . Differential diagnosis of tuberculous pleurisy by measurement of cytokine concentrations in pleural fluid.  Tuber Lung Dis. 1997;  78 29-34
  CrossrefPubMedGoogle Scholar
• 36 Wongtim S, Silachamroon U, Ruxrungtham K. et al . Interferon gamma for diagnosing tuberculous pleural effusions.  Thorax. 1999;  54 921-924
  PubMedGoogle Scholar
• 37 Lassence A, Lecossier D, Pierre C. et al . Detection of mycobacterial DNA in pleural fluid from patients with tuberculous pleurisy by means of the PCR: comparison of protocols.  Thorax. 1992;  47 265-269
  PubMedGoogle Scholar
• 38 DeWit D, Maertens G, Steyn L. A comparative study of the PCR and conventional procedures for the diagnosis of tuberculous pleural effusion.  Tuber Lung Dis. 1992;  73 262-267
  CrossrefPubMedGoogle Scholar
• 39 Querol J M, Minguez J, Garcia-Sanchez E. et al . Rapid diagnosis of pleural tuberculosis by PCR.  Am J Respir Crit Care Med. 1995;  152 1977-1981
  PubMedGoogle Scholar
• 40 Salian N V, Rish J A, Eisenach K D. et al . PCR reaction to detect mycobacterium tuberculosis in histologic specimen.  Am J Respir Crit Care Med. 1998;  158 1150-1155
  PubMedGoogle Scholar
• 41 Marchetti G, Gori A, Catozzi I. Evaluation of PCR in detection of MTB from formalin fixed paraffin-embedded tissue: comparison of four amplification assays.  J Clin Microbiol. 1998;  36 1512-1517
  PubMedGoogle Scholar
• 42 Gamboa F, Fernandez G, Padilla E. et al . Comparative evaluation of initial and new versions of the Gen-Probe Amplified Mycobacterium Tuberculosis in respiratory and non-respiratory specimen.  J Clin Microbiol. 1998;  36 684-689
  PubMedGoogle Scholar
• 43 Palacios J J, Ferro J, Ruiz-Palma N. et al . Comparison of the ligase chain reaction with solid and liquid culture media for routine detection of MTB in non-respiratory specimen.  Eur J Microbiol Infect Dis. 1998;  17 767-772
  PubMedGoogle Scholar
• 44 Ruiz-Manzano J, Manterola J M, Gamboa F. et al . Detection of MTB in paraffin-embedded pleural biopsy specimen by commercial ribosomal RNA and DNA amplification kits.  Chest. 2000;  118 648-655
  CrossrefPubMedGoogle Scholar
• 45 Hasaneen N A, Zaki M E, Shalaby H M. et al . Polymerase chain reaction of pleural biopsy is a rapid and sensitive method for the diagnosis of tuberculous pleural effusion.  Chest. 2003;  124 2105-2111
  CrossrefPubMedGoogle Scholar
• 46 Lima D M, Colares K B, daFonseca B AL. Combined use of the polymerase chain reaction and detection of adenosine deaminase activity on pleural fluid improves the rate of diagnosis of pleural tuberculosis.  Chest. 2003;  124 909-914
  CrossrefPubMedGoogle Scholar
• 47 Light R W. Pleural disease due to collagen vascular diseases. In: Light RW. Pleural Diseases, Fourth Edition Williams & Wilkinson 2001: 208-224
  Google Scholar
• 48 Khare V, Baethge B, Lang S. et al . Antinuclear antibodies in pleural fluid.  Chest. 1994;  106 866-871
  PubMedGoogle Scholar
• 49 Pettersen T, Klockars M, Hellström P E. Chemical and immunological features of pleural effusions: comparison between rheumatoid arthritis and other diseases.  Thorax. 1982;  37 354-361
  PubMedGoogle Scholar
• 50 Starr R L, Sherman M E. The value of multiple preparations in the diagnosis of malignant pleural effusions.  Acta Cytol. 1991;  35 533-537
  PubMedGoogle Scholar
• 51 Fetsch P A, Abati A. Immunocytochemistry in effusion cytology: a contemporary review.  Cancer Cytopathol. 2001;  93 293-308
  PubMedGoogle Scholar
• 52 Hsu C. Cytologic detection of malignancy in pleural effusion: A review of 5255 samples from 3811 patients.  Diagnost Cytopathol. 1987;  38 8-12
  PubMedGoogle Scholar
• 53 Loddenkemper R, Grosser H, Gabler A. et al . Prospective evaluation of biopsy methods in the diagnosis of malignant pleural effusions: intrapatient comparison between pleural fluid cytology, fine needle biopsy and thoracoscopy.  Am Rev Respir Dis. 1983;  127: Suppl. 4 114A
  PubMedGoogle Scholar
• 54 Sahn S A. Pleural effusion in lung cancer.  Clin Chest Med. 1993;  14 189-200
  PubMedGoogle Scholar
• 55 Guzman J, Bross K J, Costabel U. Malignant pleural effusions due to small cell carcinoma of the lung: An immunocytochemical cell surface analysis of lymphocytes and tumour cells.  Acta Cytol. 1990;  2 497-501
  PubMedGoogle Scholar
• 56 Antony V B, Loddenkemper R, Astoul P. et al . ATS/ERS statement: Management of malignant pleural effusions.  Am J Respir Crit Care Med. 2000;  162 1987-1901
  CrossrefPubMedGoogle Scholar
• 57 Hufnagl P, Martin H, Guski H. Diagnostic value of different features describing AgNOR patterns.  Anal Cell Pathol. 1996;  10 225
  PubMedGoogle Scholar
• 58 Yu C J, Shew J Y, Liaw Y S. et al . Application of a mucin quantitative competitive reverse transcription polymerase chain in assisting the diagnosis of malignant pleural effusion.  Am J Respir Crit Care Med. 2001;  164 1312-1318
  PubMedGoogle Scholar
• 59 Han A C, Filstein M R, Hunt J V. et al . N-Cadherin distinguishes pleural mesotheliomas from lung adenocarcinomas.  Cancer Cytopathol. 1999;  87 83-86
  PubMedGoogle Scholar
• 60 Fischer M, Günter S, Müller K M. Deutsches Mesotheliomregister Bochum. Faserjahre, Asbestbelastung der Lungen, Asbestosen.  Pneumologie. 2000;  54 155-159
  Article in Thieme ConnectPubMedGoogle Scholar
• 61 Romero S, Fernandez C, Arriero J M. et al . CEA, CA15-3 and CYFRA-21 in serum and pleural fluid of patients with pleural effusions.  Eur Respir J. 1996;  9 17-23
  CrossrefPubMedGoogle Scholar
• 62 Frank W, Herziger D, Gogolin J. Wert der Tumormarkerbestimmung im Pleuraerguss.  Pneumologie. 1998;  Suppl. 15 53
  PubMedGoogle Scholar
• 63 Mezger J, Lamerz R, Bresgen M. et al . Carcinoembryonales Antigen im Serum und Pleuraerguss zur Unterscheidung von Bronchialkarzinom und Mesotheliom.  DMW. 1991;  116 207-211
  PubMedGoogle Scholar
• 64 Heffner J E, Heffner J N, Brown L K. Multilevel and continuous pleural fluid pH likelihood ratios for evaluating malignant pleural effusions.  Chest. 2003;  123 1887-1894
  CrossrefPubMedGoogle Scholar
• 65 Silva-Mejas C, Gambao-Antinolo F, Lopez-Cortes L F. et al . Interleukin-1β in pleural fluids of different etiologies.  Chest. 1995;  108 942-945
  PubMedGoogle Scholar
• 66 Ashitani J, Mukae H, Nakazato M. et al . Elevated pleural fluid levels of defensins in patients with empyema.  Chest. 1998;  113 778-794
  PubMedGoogle Scholar
• 67 Vives M, Porcel J M, Gazquez I. et al . Pleural SC5b-9: A test for identifying complicated parapneumonic effusion.  Respiration. 2000;  67 433-438
  CrossrefPubMedGoogle Scholar
• 68 Salamaa E R, Viander M, Saaresranta T. et al . Complement components and their activation products in pleural fluid.  Chest. 1998;  114 723-730
  PubMedGoogle Scholar
• 69 Horvath L L, Gallup R A, Worley B D. et al . Soluble leucocyte selectin in the analysis of pleural effusions.  Chest. 2001;  120 362-368
  CrossrefPubMedGoogle Scholar
• 70 Porcel J M, Vives M, Esquerda A. Tumor necrosis factor-α in pleural fluid. A marker of complicated parapneumonic effusions.  Chest. 2004;  125 160-164
  CrossrefPubMedGoogle Scholar
• 71 Mohammed K A, Nasreen N, Ward M J. et al . Helper T-cell type 1 and 2 cytokines regulate CC-chemokine expression in mouse pleural mesothelial cells.  Am Respir Crit Care Med. 1999;  159 1653-1659
  PubMedGoogle Scholar
• 72 Rodriguez-Panadero F, Segado A, Martin Juan J. et al . Failure of talc pleurodesis is associated with increased pleural fibrinolysis.  Am J Respir Crit Care Med. 1995;  151 785-790
  PubMedGoogle Scholar
• 73 Chung C L, Chen Y C, Chang S C. Effect of repeated thoracentesis on fluid characteristics, cytokines and fibrinolytic activity in malignant pleural effusion.  Chest. 2003;  123 1188-1195
  CrossrefPubMedGoogle Scholar
• 74 Thicket D R, Armstrong L, Millar A B. Vascular endothelial growth factor (VEGF) in inflammatory and malignant pleural effusions.  Thorax. 1999;  54 707-710
  PubMedGoogle Scholar
• 75 Kraft A, Weindel K, Ochs A. et al . Vascular endothelial growth factor in the sera and effusions of patients with malignant and nonmalignant disease.  Cancer. 1999;  85 178-187
  CrossrefPubMedGoogle Scholar
• 76 Xiao C M, Brien T P, Ross J S. et al . Telomerase activity in benign and malignant cytologic findings.  Cancer Cytopathol. 1999;  87 93-98
  PubMedGoogle Scholar
• 77 Takahashi K, Saito S, Kamamura Y. et al . Prognostic value of CD4+ lymphocytes in pleural cavity of patients with non-small cell lung cancer.  Thorax. 2001;  56 639-642
  CrossrefPubMedGoogle Scholar
• 78 Colt H G, Mathur P N. Closed-needle pleural biopsy. In: Colt HG, Mathur PN (eds.). Manual of pleural procedures. Lippincott: Williams & Wilkins 1999: 105-114
  Google Scholar
• 79 O'Connor S, Yung T. A comparison of Abrams and Raja pleural biopsy needles.  Aust NZJ Med. 1992;  22 237
  PubMedGoogle Scholar
• 80 Radja G O, Argaval V, Vizoli L D. et al . Comparison of the Raja and the Abrams pleural biopsy needles in patients with pleural effusion.  Am Rev Respir Dis. 1993;  147 1291-1294
  PubMedGoogle Scholar
• 81 Chretien J, Daniel C J. Needle pleural biopsy. In: Chretien J, Bignon J, Hirsch A (eds.). The pleura in health and disease. New York: Marcel Dekker 1985: 631-642
  Google Scholar
• 82 Cope C. New pleural biopsy needle - preliminary study.  J Am Med Ass. 1958;  167 1107-1108
  PubMedGoogle Scholar
• 83 Kirsch C M, Kroe D M, Azzi R L. et al . The optimal number of pleural biopsy specimens for a diagnosis of tuberculous pleurisy.  Chest. 1997;  112 702-706
  CrossrefPubMedGoogle Scholar
• 84 Jacobaeus H C. Über die Möglichkeit, die Zystoskopie bei Untersuchung seröser Höhlen anzuwenden.  Münch Med Wschr. 1910;  40 2090-2092
  PubMedGoogle Scholar
• 85 Loddenkemper R. Zur Geschichte und Zukunft der Thorakoskopie.  Pneumologie. 2004;  58 42-49
  Article in Thieme ConnectPubMedGoogle Scholar
• 86 Menzies R, Charbonneau M. Thoracoscopy for the diagnosis of pleural disease.  Ann Intern Med. 1991;  114 271-278
  PubMedGoogle Scholar
• 87 Brandt H J, Loddenkemper R, Mai J. Atlas der diagnostischen Thorakoskopie. Stuttgart: Thieme Verlag 1984
  Google Scholar
• 88 Boutin C, Viallat J R, Aelony Y. Practical thoracoscopy. Berlin: Springer 1991
  Google Scholar
• 89 Loddenkemper R. Thoracoscopy: state of the art.  Eur Respir J. 1998;  11 213-221
  CrossrefPubMedGoogle Scholar
• 90 Loddenkemper R, Fabel H, Konietzko N. et al . Diagnostisches Vorgehen beim Pleuraerguss. Deutsche Gesellschaft für Pneumologie. Empfehlungen zur Diagnostik und Therapie von Lungenkrankheiten.  Pneumologie. 1994;  48 278-280
  PubMedGoogle Scholar
• 91 Loddenkemper R, Frank W. Invasive pulmonary diagnostic procedures: pleural diagnostic procedures. In: Crapo D, Glassroth J, Kalinski J et al. (eds.). Textbook of Pulmonary Diseases 7th edition. Lippincott: Williams & Wilkins 2004
  Google Scholar
• 92 Colt H G. Thoracoscopy: Window to the pleural space.  Chest. 1999;  116 1409-1415
  CrossrefPubMedGoogle Scholar
• 93 Frank W, Herziger D. Medical Thoracoscopy in Germany: A current national status report (abstract).  Pneumologie. 1999;  53 S10
  PubMedGoogle Scholar
• 94 Boutin C, Rey F, Viallat J R. Prevention of malignant seeding after invasive diagnostic procedures in patients with pleural mesothelioma: A randomized trial of local radiotherapy.  Chest. 1995;  108 754-758
  CrossrefPubMedGoogle Scholar
• 95 Loddenkemper R, Grosser H, Mai J. et al . Diagnostik des tuberkulösen Pleuraergusses: prospektiver Vergleich laborchemischer, bakteriologischer, zytologischer und histologischer Untersuchungsergebnisse.  Pneumologie. 1983;  37 1153-1156
  PubMedGoogle Scholar
• 96 Diacon A H, Wal B W van de, Wyser C. et al . Diagnostic tools in tuberculous pleurisy: a direct comparative study.  Eur Respir J. 2003;  22 589-591
  CrossrefPubMedGoogle Scholar
• 97 Frank W. Tuberculous pleural effusions. In: Loddenkemper R, VB Antony VB (Hrsg.). Pleural Diseases. Eur Respir Mon 2002 7 (22): 219-233
  Google Scholar
• 98 Canto-Armengod A, Rivas J, Saumench J. et al . Points to consider when choosing a biopsy method in cases of pleurisy of unknown origin.  Chest. 1983;  84 176-179
  PubMedGoogle Scholar
• 99 Canto-Armengod A. Thoracoscopy: Diagnostic results in secondary malignant pleural effusions.  Pneumologie. 1989;  43 58-60
  PubMedGoogle Scholar
• 100 Adams R, Gray W, Davies R JO. et al . Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma.  Chest. 2001;  120 1798-1802
  CrossrefPubMedGoogle Scholar
• 101 Prakash U BS, Reiman H M. Comparison of needle biopsy with cytologic analysis for the evaluation of pleural effusion: analysis of 414 cases.  Chest. 1983;  84 176
  PubMedGoogle Scholar
• 102 Boutin C, Frey F, Gouvernet J. et al . Thoracoscopy in pleural malignant mesothelioma. A prospective study of 188 consecutive patients. Part 1: Diagnosis, Part 2: Prognosis and Staging.  Cancer. 1993;  72 389-404
  CrossrefPubMedGoogle Scholar
• 103 International Mesothelioma Interest Group . A proposed new international TNM system for malignant mesothelioma.  Chest. 1995;  108 1122-1128
  CrossrefPubMedGoogle Scholar
• 104 Rodriguez-Panadero F, Antony V B. Pleurodesis: state of the art.  Eur Respir J. 1997;  10 1648-1654
  CrossrefPubMedGoogle Scholar
• 105 Seijo L M, Sherman D H. Interventional pulmonology.  N Engl J Med. 2001;  344 740-749
  CrossrefPubMedGoogle Scholar
• 106 Mathur P N. Medical Thoracoscopy: The Pulmonologists Perspective.  Sem Respir Crit Care. 1997;  18 803-816
  PubMedGoogle Scholar
• 107 Mairinger Th. Acceptance of telepathology in daily practice.  Analyt Cell Pathol. 2000;  21 135-140
  PubMedGoogle Scholar

Bereits publizierte Beiträge zu dieser Serie:

• 01 Bildgebende Diagnostik bei Pleuraerkrankungen.  Pneumologie. 2004;  58 238-254
  Google Scholar
• 02 Pleura: Pathologie nicht-neuroplastischer Erkrankungen.  Pneumologie. 2004;  58 516-524
  Google Scholar
• 03 Pleuramesotheliom - Pathologie und Pathogenese.  Pneumologie. 2004;  58 670-679
  Google Scholar

Wolfgang Frank

Klinik III, Pneumologie · Johanniterkrankenhaus im Fläming

Johanniterstr. 1

14929 Treuenbrietzen

Email: frank@johanniter-treuenbrietzen.de