Efficacy of Pleural Brush Cytology in the Diagnosis of Pleural Diseases

Objective To describe the role of medical thoracoscopy in the diagnosis and treatment of pleural diseases in children. Methods Thoracoscopy procedures had been carried out in 9 patients with recurrent pleurisy and pleural effusion who were hospitalized in Department of Pulmonary, Intervention Qilu Children's Hospital of Shandong University from no vember 2013 to June 2015.Pleural biopsy was performed under direct visual guidance to obtain tissues, and pleural adhesion and cellulose exudation had been cleaned out in 7 cases. Results Six cases of the 9 patients had been diagnosed with tuberculous pleurisy.Pleural tumor and infectious diseases had been exclused in 1 case with biateral pleural and pericardial effusion, thickened heart capsule was found in the operation, then continuous cardiac ultrasound examination confirmed the diagnosis of constrictive pericarditis after the medical thoracoscopy procedure.The clinical symptoms were controlled in 1 case of lung abscess and empyema after cleaning out the pus moss and necrotic tissue with anti-infective therapy, the pleural adhesion was reduced.One case with empyema was converted to thoracic surgery as combined with severe pleural adhesion.Medium bleeding was found in 1 case during the procedure.Minor pneumothorax and subcutaneous emphysema occurred in 1 case after operation.There were no severe complications in the other 7 patients. Conclusions As a modern intervention technique of diagnosis and treatment of respiratory system disease, thoracoscopy is a safe and effective technique for pediatric patients. Key words: Pleural disease; Medical thoracoscopy; Child

Pleural effusion (PE) is a complex etiology and affects the life quality life of patients.Invasive techniques play an important role in the diagnosis of PE.We mainly focus on the clinical application and evaluation of invasive techniques such as thoracocentesis, pleural biopsy and medical thoracoscopy in diagnosis of PE.Thoracocentesis is a simple, convenient and relatively safe technique with less complications which is often used as the initial diagnostic procedure.As pleural biopsy can provide pathological and histological specimens, its confirmed value is superior to conventional methods for diagnosis of PE.However, the positive rate is not satisfied and it can be improved when pleural biopsy is guided by ultrasound or computed tomography (CT). Pleural biopsy has great value in basic-level hospitals.Medical thoracoscopy can visually and clearly display almost whole of the pleura and lungs.Minor lesions and suspicious site can be showed for biopsy with medical thoracoscopy.As a result, the positive rate increases greatly and accordingly.In a word, medical thoracoscopy is a valuable and safe tool with a higher diagnostic rate and lower incidence of complications in clinic. Key words: Pleural effusion; Thoracocentesis; Pleural biopsy; Thoracoscopy; Interventional pulmonology

Objective To study the value of medical thoracoscopy in the diagnosis of cryptogenic pleural effusions.Methods Medical thoracoscopy was performed in 106 patients with cryptogenic pleural effusion.Pleural biopsies were routinely performed.Results Pathologic diagnosis was obtained in 102 patients,with pleural metastasis of lung cancer in 28 cases,malignant pleural mesothelioma in 9 cases,malignant lymphoma in l case,pleural metastasis of other cancer in 3 cases,pleural tuberculosis in 40 cases,inflammation in 16 cases and sarcoidosis in 1 case.No abnormality was seen by medical thoracoscopy in 4 patients.Conclusions Medical thoracoscopy is a safe and well-tolerated procedure with high diagnostic accuracy to cryptogenic pleural effusion,and ideal pleural organ can be obtained under direct vision.The positive rate of diagnosis of pleural effusions is improved significantly by medical thoracoscopy. Key words: Pleural effusion; Thoracoscopy

Objective To investigate the value of medical thoracoscopy in the diagnosis of pleural effusion of unknown etiology.Methods 108 patients with pleural effusion of unknown etiology were underwent medical thoracoscopy examinantion and biopsy for diagnosis in our hospital from 2011 to 2013.And the process,results,and safety were retrospectively analysed.Results The biopsy tissue and pathological diagnosis of 106 patients with pleural effusion were obtained,including 52 cases of tuberculous pleurisy,45 cases of malignant tumor,three cases of pneumonia with pleurisy,six cases of nonspecific inflammation.Two cases with serious pleural adhesions were failed to obtain biopsy tissue.The diagnostic positive rate was 92.6％.Two patients complicated with pneumothorax after the operation,the rest patients had no serious complications in and after the operation.Conclusions Medical thoracoscopy can be applied to diagnose the pleural effusion of unknown etiology and it is a safe method with higher diagnostic rate and clinical value. Key words: Medical thoracoscopy; Pleural effusion ; Etiology

Objective To analyse the value of medical thoracoscopy in the diagnosis of unknown pleural effusion and its safety.Methods 92 cases of unknown pleural effusion treated in our department of respiratory medicine and intensive medicine from April 2010 to April 2013 were examined through medical thoracoscopy,pleural lesion was observed,and the abnormal parts were made biopsy and pathologic examination.Results In 92 patients with pleural effusion,84 cases were diagnosed,the positive rate of diagnosis was 91.3 ％,in which 48 cases were malignant pleural effusion,29 cases were tuberculous pleural effusion,four cases were nonspecific inflammation,two cases were purulent pleuritis,one case was sarcoidosis,8 cases had unknown etiology,11 cases had postoperative pain,three cases had fever,and one case had bleeding.Conclusions Medical thoracoscopy is helpful to further clarify the causes of unexplained pleural effusion with superior tolerability,safety,and effectivity,it is worth clinical application. Key words: Medical thoracoscopy ; Pleural effusion of unknown causes : Diagnosis

Objective To explore the clinical diagnostic value of pleural biopsy combined with carcinoembryonic antigen (CEA),cytology on patients with unexplained pleural effusion.Methods 176 patients with unexplained pleural effusion were divided into two groups by diagnostic results:malignant pleural effusion group (malignant group,n =79) and tuberculous pleural effusion group (tuberculous group,n =67).The serum CEA,pleural effusion CEA,pleural fluid CEA/serum CEA,and cytology were compared between the two groups.Results ① The serum CEA,pleural effusion CEA,pleural fluid CEA/serum CEA in the malignant group were significantly higher than those in the tuberculous group (P ＜0.05).②The sensitivity and specificity of cytology were 87.34％ and 100.00％,they were 17.72％ and 49.25％ by CEA of pleural effusion,they were 58.23％ and 76.12％ by CEA in peripheral blood,they were 77.22％ and 83.58％ by pleural fluid CEA/blood CEA.There was statistical significance on the sensitivity and specificity among different methods (P ＜0.05).The sensitivity and specificity of cytology were the highest,following by pleural fluid CEA/blood CEA,those of blood CEA were the lowest.Conclusions Pleural biopsy combined with CEA,cytology can effectively check the cause of unexplained pleural effusion,and help to identify benign and malignant pleural effusion,worthy of clinical application. Key words: Pleural effusion ; Pleural biopsy; Cytology ; Carcinoembryonic antigen

Introduction Medical thoracoscopy is an important tool for the diagnosis and management of several pleural diseases. The presence of fibrous pleural adhesions may prevent medical thoracoscopy to access the pleural space properly, which may lower the diagnostic yield of the procedure and may also increase the risk for associated complications. The role of on-table chest ultrasound (US) before medical thoracoscopy is investigated in this study. Aim of the study The aim of this study was to evaluate the utility of on-table chest US before medical thoracoscopy and its ability to locate a safe point of entry, its impact on the facility of the procedure, and the risk for complications. Patients and methods Forty patients who underwent medical thoracoscopy for investigation of undiagnosed pleural effusion were included in this study. They were randomized into two groups. In group I, chest US was performed on table immediately before medical thoracoscopy and in group II, no chest US was performed. Results Computed tomography chest detected pleural adhesions in one patient (5%) in group I and in two patients (10%) in group II, whereas medical thoracoscopy detected five patients (25%) in group II and six patients (30%) in group I. Chest US was able to detect all cases with pleural adhesions in group I. Four patients (20%) in group II needed extra procedures to access the pleural cavity due to unsuccessful primary point of entry, and two (10%) had complications in the form of bleeding. All patients in group I had successful access to the pleural cavity with no needed extra procedures and no complications. The mean duration of the procedure in group I was 42 ± 5.4 versus 50 ± 10.4 min in group II. Conclusion Chest US performed before medical thoracoscopy can facilitate the procedure; it reduces the unsuccessful attempts to access the pleural cavity, minimizes the risk for complications, and reduces the duration of the procedure.

Objective To disscuss the value of medical thoracoscopy in the diagnosis of malignant pleural effusion and probe the clinical significance of the diagnosis of malignant pleural effusion of the level of carcinoembryonic antigen (carcino-embryonic antigen, CEA) in pleural fluid, serum. Methods We analyzed retrospective the clinical data of 77 patients with pleural effusion during August 2015 to August 2016.We took the medical thoracoscope pathological results as the gold standard and evaluated the value of the level of CEA in pleural effusion and in serum and the pleural effusion/serum CEA ratio to diagnosis malignant pleural effusion. Results ①Among the 77 patients with pleural effusion, medical thoracoscope could clearly diagnosis 74 of them (46 of them were with malignant pleural effusion, 27 of them were with tuberculous pleural effusion, 3 of them were with pneumonia pleural effusion in cases, one was with nonspecific inflammation incase), the diagnostic rate was 96.1%.②The level of CEA in serum、in pleural effusion and the pleural effusion/serum CEA ratio in the malignant pleural effusion groupobviously were higher than that in pleural effusion group.Therefore, the level of CEA in pleural effusion of ladenocarcinoma were significantly higher than thoseother types of pleural effusion.③The sensitivity of the CEA in pleural effusion, specificity and accuracy ratio (80.4%, 89.3%, 83.7%) were higher than that in serum CEA and the pleural effusion/serum CEA ratio (56.5%, 78.5% and 64.9%, respectively, 93.4%, 64.2%, 82.4%). Conclusions ①Medical thoracoscopy is a safe, effective, practical diagnosis method which is worth to popularizing widely.②The CEA levels in the body, especially in pleural effusion, is significant to diagnosis the malignant pleural effusion(especially in adenocarcinoma). It can be used as an auxiliary diagnostic index for clinical application. Key words: Pleural effusion, malignant; Medical thoracoscopy; The CEA in serum; The CEA in pleural effusion; Pleural effusion/serum CEA ratio

Introduction: In our practice, etiological diagnosis of pleural effusion is sometimes difficult despite cytological, biochemical and microbiological tests. The aim of the present study was to make an etiological diagnosis by means of closed pleural biopsy in undiagnosed pleural effusions. Methods:The study group consisted of patients with exudative pleural effusion where etiology was not determined by means of conventional cytological, biochemical and microbiological investigations. Pleural tissue was obtained by Abrams pleural biopsy needle. Pleural biopsy was subjected to histopathology, Ziehl-Neelsen (Z-N) staining and mycobacterial culture. Results:Four hundred fifty eight patients with pleural effusion were screened over three years and 82 of them were found to have undiagnosed exudative effusion after investigations, as mentioned in the Method section. The age of the 82 subjects [56 (68.29%) men and 26 (31.71%) women] ranged from 15 to 65 years (mean 32.6). Histopathology showed epitheloid granuloma with caseation necrosis in 50 (60.9%) patients and non-specific chronic inflammation in 14 (17.1%) subjects. Ziehl-Neelsen stain was positive for acid fast bacilli (AFB) in 10 (12.2%) patients and culture of pleural tissue showed the presence of Mycobacterium tuberculosis in 18 (21.9%) patients. Conclusion:In the era of thoracoscopy, percutaneous closed needle pleural biopsy still holds a significant role in cases of undiagnosed exudative pleural effusions where thoracoscopy is not available, being also a cost effective approach for developing countries. It can achieve specific diagnosis among 86.6% of cases with undiagnosed exudative pleural effusions.

Objectives The aim of this study was to assess the value of the pleural fluid soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in the diagnosis of the etiology of pleural effusion. Background The accurate diagnosis of pleural effusion remains a challenging problem even after thoracocentesis and closed pleural biopsy. TREM-1 is a recently described molecule that plays an important role in myeloid cell-activated inflammatory responses. Patients and methods We measured sTREM-1 levels from 20 patients with transudative effusion, 20 patients with malignant effusion, 20 patients with tuberculous effusion, and 20 patients with parapneumonic effusion using a specific enzyme-linked immunosorbent assay technique. Result sTREM-1 levels were significantly higher in parapneumonic effusion (45.50 ± 13.21 ng/l) than tuberculous effusion (34.90 ± 10.51 ng/l) and in malignant effusion (15.37 ± 5.01 ng/l) than transudative effusion (6.75 ± 3.35 ng/l). Conclusion Our study suggests that sTREM-1 can differentiate between infectious effusions (parapneumonic and tuberculous) and noninfectious effusions (malignant and transudative effusions).

A pleural effusion is an abnormal collection of fluid in the pleural cavity. Pleural effusion is a common manifestation in a wide range of diseases, including pleural, pulmonary and extra-pulmonary disorders, where the most frequent of these are congestive heart failure, pneumonia and malignancy. This review provides a systematic approach to manage the patient with pleural effusion in order to have a correct diagnosis quickly and without additional invasive methods beginning with medical history, clinical examination, radiology, pleural fluid analysis and finally, if there is a need, a pleural biopsy and/or thoracoscopy. The first step of the fluid analysis includes differentiation transudate from exudates based on Light’s criteria and after that suggests the tests which are necessary for the further investigation of exudates (biochemical characteristics, cultivation, cytology, test for tuberculosis, immunological tests). These steps are very important because early diagnosis improves prognosis and minimizes complications.

In a consecutive series of 1,000 patients admitted since 1970 for pleural effusions, 215 with undiagnosed chronic effusions (with previous negative cytologic and needle biopsy results) underwent thoracoscopy. The investigation was usually performed under general anesthesia, originally with a 9-mm diameter cold light laparoscope, but, since 1978, with a 7-mm diameter thoracoscope of our design with biopsy forceps connected to a diathermocoagulating device. Thoracoscopy diagnosed 131 of 150 malignant effusions in the series. We observed no false positive results. A repeat pleural cytology and needle biopsy performed the day before thoracoscopy yielded only 41% positive results. The higher yield by our new thoracoscope (97% positive results, versus 78% with the laparoscope) can be accounted for by a better visualization of the pleural space, easier handling of biopsy material, and the systematic use of diathermocoagulation. Complications were rare, minor, and not life-threatening.

Objective To determine chest ultrasound locating treatment of paraelectronic effusion by medical thoracoscopy. Methods We chose 40 Xinxiang center hospital patients in respiratory wards from June 2012 to June 2014, who was randomly divided into two teams, one was electron-assisted Thoracoscopic surgery, the other was thoracic cavity closed drainage combination of intrapleural injection of urokinase. It was 3rd reviewed by chest ultrasound, we evaluated curative effection according to the drainage effect, we statisticsed two draining days and total inpatient days, and total hospital costs. The results two teams were compared between gender, age, nutritional status, effusion volume (length x width x depth) , pleural effusion conventional, biochemical, lactate dehydrogenase, adenosine deaminase, carcinoembryonic antigen, the difference was not statistically significant (P>0.05) . Pleural fluid culture results were negative. Medical thoracoscopy treatment group hospitalization days, drainage time was significantly shorter than the thoracic drainage combined with pleural urokinase group, The same was the cost of hospitalization. Medical thoracoscopy poor drainage treatment group was significantly lower than the thoracic drainage combined with pleural urokinase group (P<0.05) . Conclusion To the middle-large number encapsulated paraelectronic effusion , chest ultrasound locating treatment by medical thoracoscopy early can reduce the formation of empyema, reduce the formation of pleural fiberboard. It is a safe, effective and worthy of promotion treatment. Key words: Electronic medical thoracoscopy pneumonia; Paraelectronic effusion clear fibreprotein

Objective To discuss the diagnostic value of medical thracoscopy on pleural effusion of unknown origin and conclude imaging characteristics of various causes of pleural effusion under medical thracoscopy. Methods Retrospective analysis of the causes of ninety patients with pleural effusion.All the patients were collected clinical information and thoracoscopic image characters. Results Among ninety cases of patients with pleural effusion, the most common causes were inflammation and malignance (26.7%, 55.6%). In clinical information, yellow effusion was common in tuberculosis, and blood was common in malignant effusion.Under medical thoracoscopy miliary nodules and extensive adhesion were common in tuberculosis; separation, wrapping and diffuse nodules were common in malignant effusion. Conclusions The most common causes of pleural effusion of unknown origin are malignance, inflammation and tuberculosis.Combination of clinical information, pleuraleffusion biochemical test and medical thoracoscopy could improve diagnostic efficiency of pleural effusion.Medical thoracoscopy has the advantages of limit wound, rapid recovery and high safety, which should be a standard diagnostic method for pleural effusion of unknown origin. Key words: Thoracoscopy; Pleural effision; Diagnosis

Background: Medical thoracoscopy is a procedure which enables pneumologist to inspect the pleural space, perform biopsy, pleurodesis, and facilitates optimal chest tube placement and drainage in patients with pleural effusion. We made a retrospective analysis of the procedures, performed at the University Hospital Golnik between January 2002 and December 2007. Patients and methods: We evaluated 129 thoracoscopies, performed in 125 patients in a 5-year period. All patients had pleural effusion or a pleural mass, which failed to be diagnosed by less invasive diagnostic methods. In the study group there were 90 (72.0 %) men and 35 (28.0 %) women. Their median age was 63 years (from 28 to 81 years). All procedures were performed under local anaesthesia with a videothoracoscope Olympus A5252A. Pleurodesis was performed by insufflation of 5g of talc. Results: 78 (62.4 %) of patients had malignant infiltration of the pleura and 47 (37.6 %) had a benign pleural disease. The diagnostic accuracy of thoracoscopy was 91.5 %. The sensitivity in the diagnostics of malignant pleural disease was 86.1 %, the negative predictive value was 82.0 %. Talc pleurodesis was performed in 14 patients with malignant pleural infiltration. Complications were detected in 33 (26.4 %) patients, most of them were not severe. Severe complications, such as empyema, bronchopleural fistula, prolonged duration of drainage, perforation of the diaphragm and trapped lung, occurred in 8 (6.4 %) patients. 30-day mortality rate after the procedure was 0 %. Conclusions: Thoracoscopy has a high diagnostic yield with an acceptably low rate of complications. Nevertheless, it is an invasive procedure, which requires careful indications, patient’s consent, best surgical technique and an accurate postoperative follow up.