Smear cytology of Pleural nodule during Thoracoscopy - A new approach for early diagnosis of Pleural pathology.

Abstract

Morphological appearance of Pleural nodules during thoracoscopy are not 100% diagnostic of Malignancy or TB. An early definite etiological diagnosis will help to decide the further treatment plan. Methods: During Medical thoracoscopy, Pulmonologist prepared Cytology smears slides directly from parietal pleura nodule biopsy tissue. Cytologist provided the smear cytology results in one day. Data were retrospectively reviewed, and Cytology results were compared with final pleural biopsy histopathology report. Results: 40 patients underwent Medical thoracoscopy for undiagnosed pleural effusion at a tertiary care hospital in South India. 33 patients were male and the average age of patients was 58 years. The final diagnosis was Malignant pleural effusion in 35 cases (29 cases of Lung cancer, 3 cases of Mesothelioma, one case of Lymphoma and 2 cases of metastatic carcinoma) and pleural Tuberculosis in 5 patients. Nodules were found on parietal pleura in 38 cases. Smear cytology of Parietal pleura biopsy tissue was positive in 39 cases (97.5%) and perfectly matched with final histopathology report. It failed to show any significant pathology in only one case (2.5%) with pleural tuberculosis. Average time to get Pleural biopsy final histopathology report was 6 days after thoracoscopy, while smear cytology from pleural biopsy tissue provided the diagnosis within one day of thoracoscopy. During Medical thoracoscopy, Smear cytology slides from pleural biopsy tissue can provide early diagnosis. It can help in taking an early decision regarding further treatment plan like doing pleurodesis, requesting for mutation analysis or starting antiTB treatment and removal of the chest tube.