Clinical long-term outcome of non-specific pleuritis (NSP) after surgical or medical thoracoscopy

Abstract

Background: Thoracoscopy, either “medical” or “surgical”, is the gold standard to reveal the cause of pleural effusion by taking large biopsies. However, in some cases, the histology of pleural biopsies is inconclusive describing a variable process of inflammation, encompassing for non-specific pleuritis (NSP). Questions are raised whether the surgical (or VATS) is doing better than the medical thoracoscopy (MT), but no direct comparison between the two techniques exist in the current bibliography. The Aim: of our retrospective study was to compare these two techniques to find whether there is any difference in the false negative cases of NSP. Methods: We included in our study 295 patients with NSP, 179 patients who underwent VATS comparing to 116 patients who underwent MT for pleural effusion of initially undetermined cause, having a follow-up of at least one year. Analysis of patients’ files, history, clinical examinations, further tests, and follow-up were recorded. Results: The mean age of our patients was 58.5±19.1 and M/F gender was 216/79; no difference was observed between the two groups. A previous history of cancer was noted in 36 patients (12.2%). The mean follow-up period was 47.3±20.7 months. 3 patients were diagnosed with mesothelioma during the follow-up: with VATS, only one patient (0.55%) (false negative), while with MT 2 patients (1.7%). Negative predictive value for pleura-related malignancy for VATS was 0.994 and for MT 0.982. Conclusion: In patients with histological diagnosis of NSP both VATS and MT showed similar and excellent results of false negative cases and negative predictive value in excluding malignant pleural disease.