Diagnostic Yield Of Medical Thoracoscopy Research Articles

Unveiling Insights: A Comprehensive Review of the Role of Medical Thoracoscopy in Pleural Effusion Assessment.

Pleural effusion, characterized by abnormal fluid accumulation in the pleural cavity, poses diagnostic and therapeutic challenges across various medical conditions. This comprehensive review explores the role of medical thoracoscopy in assessing pleural effusions, providing insights into its historical context, procedural intricacies, diagnostic performance, safety considerations, and clinical applications. Medical thoracoscopy, a minimally invasive endoscopic procedure, offers advantages such as high diagnostic yield, therapeutic interventions, real-time assessment, and a minimally invasive nature. The review critically analyzes the procedure's advantages and disadvantages, including technical expertise, risk of complications, resource intensity, and patient selection criteria. Comparative analyses with alternative diagnostic modalities highlight the unique benefits of medical thoracoscopy in specific clinical scenarios. The diagnostic yield of medical thoracoscopy is examined, considering sensitivity and specificity in various contexts. Patient selection criteria, complications, and safety measures are discussed, emphasizing the importance of careful consideration in integrating thoracoscopy into clinical practice. The review further explores its clinical applications, including differentiating exudative and transudative effusions, identifying specific etiologies, and its role in treatment planning. In conclusion, medical thoracoscopy emerges as a valuable tool in the comprehensive management of pleural effusions, offering a nuanced approach to diagnosis and treatment. The evolving landscape of diagnostic modalities underscores the continued significance of medical thoracoscopy and potential advancements in the field.

Scope of medical rigid thoracoscopy in patients with pleural effusion of unknown etiology: A prospective single center study

Background: Pleural diseases commonly encountered are pleural effusion, pneumothorax, pleural wall thickening, and pleural mass. Medical thoracoscopy is a minimally invasive procedure that allows diagnostic and therapeutic intervention. The medical diagnostic thoracoscopy in local anesthesia is a simple, low-cost investigation with relatively high diagnostic accuracy, no mortality, and low morbidity. A diagnosis of pleural tuberculosis (TB) could be achieved in 99% of patients as against 51% using closed pleural biopsy. Aims and Objectives: Assessment of the role of medical rigid thoracoscopy in patients with pleural effusion of unknown etiology in a tertiary health care setup. The primary objectives of the study were to evaluate the diagnostic yield of medical thoracoscopy in pleural effusion of unknown etiology. Materials and Methods: The study duration/time frame to address the study: November 2017–February 2019 sample size with Justification Sample size: Minimum 31 patients. It was a prospective observational study. All patients admitted in hospital/daycare at LHRC presenting with pleural effusion with unknown etiology. All patients had a medical thoracoscopy, and samples were sent for microbiological and histological analysis. Clinical, thoracoscopic results and histopathological data of the patients were collected prospectively and analyzed. Results: In this study, 28 patients out of 31 patients were diagnosed. The diagnostic yield of thoracoscopic pleural biopsy was 90.3% Out of 31 patients, the most common complication found was chest pain 48.4% (15/31), followed by 09.7% (03/31) of the cases had complications such as surgical emphysema, postoperative fever, and bleeding. There were no complications in 32.2% (10/31) patients. Conclusion: Medical thoracoscopy is a noble procedure that helps the pulmonologist/surgeon to inspect the pleural cavity. It is a safe and effective diagnostic as well as a therapeutic tool with a high diagnostic yield. The most common differentials of undiagnosed pleural effusion cases are TB and malignancy.

Diagnostic value and safety of medical thoracoscopy for pleural effusion of different causes.

BACKGROUNDPleural effusions occur for various reasons, and their diagnosis remains challenging despite the availability of different diagnostic modalities. Medical thoracoscopy (MT) can be used for both diagnostic and therapeutic purposes, especially in patients with undiagnosed pleural effusion.AIMTo assess the diagnostic efficacy and safety of MT in patients with pleural effusion of different causes.METHODSBetween January 1, 2012 and April 30, 2021, patients with pleural effusion underwent MT in the Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University (Shaanxi, China). According to the discharge diagnosis, patients were divided into malignant pleural effusion (MPE), tuberculous pleural effusion (TBPE), and inflammatory pleural effusion (IPE) groups. General information, and tuberculosis- and effusion-related indices of the three groups were analyzed. The diagnostic yield, diagnostic accuracy, performance under thoracoscopy, and complications of patients were compared among the three groups. Then, the significant predictive factors for diagnosis between the MPE and TBPE groups were analyzed.RESULTSOf the 106 patients enrolled in this 10-year study, 67 were male and 39 female, with mean age of 57.1 ± 14.184 years. Among the 74 thoracoscopy-confirmed patients, 41 (38.7%) had MPE, 21 had (19.8%) TBPE, and 32 (30.2%) were undiagnosed. Overall diagnostic yield of MT was 69.8% (MPE: 75.9%, TBPE: 48.8%, and IPE: 75.0%, with diagnostic accuracies of 100%, 87.5%, and 75.0%, respectively). Under thoracoscopy, single or multiple pleural nodules were observed in 81.1% and pleural adhesions in 34.0% with pleural effusions. The most common complication was chest pain (41.5%), followed by chest tightness (11.3%) and fever (10.4%). Multivariate logistic regression analyses showed effusion appearance [odds ratio (OR): 0.001, 95%CI: 0.000-0.204; P = 0.010] and carcinoembryonic antigen (OR: 0.243, 95%CI: 0.081-0.728; P = 0.011) as significant for differentiating MPE and TBPE, with area under the receiver operating characteristic curve of 0.977 (95%CI: 0.953-1.000; P < 0.001).CONCLUSIONMT is an effective, safe, and minimally invasive procedure with high diagnostic yield for pleural effusion of different causes.

Improving the yield of diagnostic medical thoracoscopy for undiagnosed exudative pleural effusions using a rigid diagnostic algorithm.

Establishing the etiology of exudative pleural effusions in the setting of an unrewarding pleural fluid analysis often requires biopsies from the parietal pleura. However, it may be noted that diagnosis such as pulmonary embolism and connective tissue diseases can result in an exudative pleural effusion where a pleural biopsy can yield nonspecific results. Medical thoracoscopy (MT) is a minimally invasive procedure performed under local anesthesia or moderate sedation with excellent yield and favorable safety profile. We analyzed the diagnostic yield of MT for exudative pleural effusions after employing a rigid diagnostic algorithm. The study was undertaken to ascertain the yield of MT in establishing the diagnosis in diagnosis of exudative pleural effusions, to find out the relative contribution of pleural tuberculosis (TB) as a cause of undiagnosed exudative pleural effusion, to describe the etiology of undiagnosed exudative pleural effusion in patients undergoing MT and to determine the correlation between pleural fluid adenosine deaminase (ADA) levels and TB pleuritis in patients undergoing MT. This was a retrospective study. Patients with undiagnosed exudative pleural effusion were included in the study. MT was performed with semirigid thoracoscope (Olympus LTF 160) under local anesthesia and conscious sedation. Gross appearance and ADA level of pleural fluid were noted. Pleural biopsy material was subjected to histopathology examination and culture for mycobacteria along with cartridge-based nucleic acid amplification test for TB. The yield of MT for establishing the etiology of pleural effusion and the relative contribution of tuberculous pleuritis as a cause of undiagnosed pleural effusion was ascertained. Correlation of pleural fluid ADA levels was done with a final diagnosis of TB pleuritis in patients undergoing MT. Twenty-five patients with undiagnosed exudative pleural effusion underwent thoracoscopy of which 16 were male and 9 were female. MT was able to establish the diagnosis in all cases, providing a diagnostic yield of 100%. Histopathological examination of biopsy specimens yielded a diagnosis of malignant involvement of pleura in 10 patients and granulomatous pleuritis consistent with TB in 14 patients. Pleural TB contributed to 60% of undiagnosed pleural effusions in the present study. The mean ADA value among those who turned positive was 56.338 and 35.300 among those who turned negative using genexpert, which was found to be statistically significant. A value of 31 IU/L showed a sensitivity of 93.3% and specificity of 99.8% and hence can be taken as a cut off value for the diagnosis of pleural TB based on receiver-operating characteristic analysis. TB contributed to 60% of undiagnosed exudative pleural effusions in the present study. MT had 100% yield in the diagnosis of undiagnosed exudative effusions. Pleural fluid ADA levels may help in differentiating TB versus malignant effusion.

Diagnostic Yield of Medical Thoracoscopy in Undiagnosed Exudative Pleural Effusion- A Tertiary Centre Experience from Aligarh Muslim University, Uttar Pradesh, India

Introduction: Pleural effusions are one of the most common entities encountered by pulmonologists worldwide which have a very long list of causes. Initial workup of these patients begins with a chest X-ray and percutaneous or Ultrasound (USG) guided thoracocentesis followed by biochemical and cytological evaluation of the fluid to ascertain the cause of effusion. A 20 to 25% of cases remain undiagnosed even after thoracocentesis and closed pleural biopsy. Medical Thoracoscopy is emerging as a safe diagnostic procedure in these patients. Aim: To detect the diagnostic yield of medical thoracoscopy in cases of undiagnosed exudative lymphocytic pleural effusion and to study the complications associated with it. Materials and Methods: This was a prospective observational study, carried out in the Department of Pulmonary Medicine, JN Medical College and hospital, Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, India, from August 2016 to August 2018. Undiagnosed exudative pleural effusion was defined as pleural effusion with Adenosine Deaminase (ADA) levels less than 70 IU/L and negative pleural fluid cytology for malignancy. Thoracoscopic examination of the pleural space using flexi-rigid thoracoscopy was done and biopsy was taken from suspected areas and the tissue obtained, was send for histopathological examination. The results were presented as mean±SD (Standard Deviation) or percentage. Differences in categorical data were compared using the chi-square test or the Fisher-exact test. A p-value of &lt;0.05 was considered statistically significant. Results: Fifty patients underwent thoracoscopy for undiagnosed pleural effusion. Most common gross thoracoscopy finding was nodules which was seen in 23 patients. Malignancy was the most common histopathological finding, seen in 22 patients. Minor complications were seen in five patients. A final diagnosis could be made in 41 patients; the diagnostic yield was 82%. Conclusion: Medical thoracoscopy should be performed in all patients in which radiological and pleural fluid examinations could not lead to a definitive diagnosis as it has high sensitivity and a very low rate of complications.

Medical thoracoscopy for exudative pleural effusion: an eight-year experience from a country with a young population

BackgroundWith the exception of areas with high prevalence of tuberculosis, medical thoracoscopy is becoming the diagnostic modality of choice for exudative pleural effusions. The aims of this study were to determine the diagnostic yield and safety of medical thoracoscopy for exudative pleural effusions and ascertain the etiology of such effusions in Qatar.MethodsThis is a retrospective-descriptive study of 407 patients who underwent diagnostic medical thoracoscopy for exudative pleural effusions from January, 2008 till December, 2015 at the only tertiary referral center performing this procedure in Qatar.ResultsTuberculosis was the most common etiology of exudative pleural effusions in Qatar accounting for 84.5% of all causes. Around 85% of patients were young males (mean age of 33 ± 12.1 years). The diagnostic yield of medical thoracoscopy for tuberculous pleural effusion was 91.4%. Malignant pleural effusions accounted for 5.2% of cases. Minor bleeding occurred in 1.2% of cases with no procedure-related mortality observed.ConclusionMedical thoracoscopy is a very safe procedure. Tuberculous pleuritis is by far the most common etiology of exudative pleural effusions in Qatar. Closed needle biopsy is a worth consideration as an initial safe, easy and low-cost diagnostic modality for exudative pleural effusions in this country.

The role of medical thoracoscopy in the diagnosis of exudative pleural effusion at the Chest Department of Zagazig University Hospitals

Thoracoscopy is a minimally invasive procedure that allows visualization of the pleural space and intrathoracic structures. It enables taking pleural biopsies under direct vision, therapeutic drainage of effusions, and pleurodesis in one sitting. Persistent and recurrent exudative pleural effusions become common and thoracocentesis and blind pleural biopsy procedures do not give a definitive diagnosis in many patients. Therefore, thoracoscopy today remains the gold standard for these cases. In tuberculous pleuritis, the combined yield of histology and culture for rigid thoracoscopy was nearly 100%. The aim of the present study was to examine the diagnostic yield of medical thoracoscopy in patients with undiagnosed exudative pleural effusion. This study was carried out at the chest department of Zagazig University Hospitals in the period from October 2014 to October 2015. It included 36 patients with undiagnosed pleural effusion. All participants signed a written informed consent. The included patients were subjected to full history taking, clinical examination, plain chest radiograph, ultrasonography, computed tomography of the chest, and tuberculosis assessment. Diagnostic aspiration of pleural fluid was performed by using chemical, cytological, and bacteriological analyses. Closed pleural biopsy was carried out in patients with unhelpful pleural fluid analysis. Lastly, if the etiology remained unknown, thoracoscopy was carried out. The present study included 18 men and 18 women patients, with a mean age of 54.4±16.1 years. Dyspnea was the most common presenting symptom among the studied patients. Sixteen (72.2%) patients had moderate right-sided pleural effusion. The diagnostic yield of medical thoracoscopy among the studied patients was 80.6%. The histopathological yield of thoracoscopic pleural biopsies was as follows: 25 (69.4%) malignant cases, two (5.6%) patients with tuberculous pleuritis, one (2.8%) patient diagnosed with empyema, and another one (2.8%) with collagenic disease. There were seven (19.4%) patients who were not diagnosed. The post-thoracoscopic complications in this study occurred only in nine (25%) patients, which were minor complications in the form of surgical emphysema and prolonged air leak, wound infection, dislodged drain, trapped lung, and pain during the procedure. Medical thoracoscopy is a good diagnostic procedure for pulmonologists to evaluate undiagnosed pleural effusions.

Ultrasound guided closed pleural biopsy versus medical thoracoscopic pleural biopsy in diagnosis of pleural diseases

BackgroundThe diagnostic approach to pleural disease remains an underappreciated aspect of modern thoracic medicine, despite the fact that pleural disease affects approximately 300 subjects per 100,000 population per year worldwide. Tissue biopsies required for diagnosis can be obtained by various methods; blind pleural biopsy, guided biopsy, medical thoracoscopic or surgical pleural biopsy. Aim of the workTo compare the diagnostic efficiency, reliability, complications and advantages of transthoracic ultrasound guided (TUS) pleural biopsies with those of medical thoracoscopic pleural biopsies in patients with pleural diseases. Patients and methodsThis study included 71 patients with pleural disease. All patients were subjected to complete history taking, full clinical examination, CT chest, TUS examination with TUS guided biopsies for legible cases and medical thoracoscopic biopsies for legible cases. The patients included in the study were classified according to the procedure by which pleural biopsy was divided into 3 groups: Group 1 (39 patients underwent medical thoracoscopic pleural biopsies alone), Group 2 (10 patients underwent TUS pleural biopsies alone), Group 3 (22 patients underwent pleural biopsies by both techniques). The patients included in the study were classified according to the pathology of the lesions into Group A (51 patients with malignant lesions) and Group B (included 20 patients with non-malignant lesions). The malignant patients included in the study were classified according to the pathology of the lesions into Group A1 (24 patients with primary malignant lesions) and Group A2 (27 patients cases with secondary malignant lesions). ResultsTUS guided pleural biopsies had a sensitivity of 77.78% and diagnostic accuracy of 81.25%; while medical thoracoscopic pleural biopsies had a sensitivity of 94% and a diagnostic accuracy of 95.08%. ConclusionBoth TUS guided pleural biopsy and medical thoracoscopic pleural biopsy are available to diagnose different pleural lesions each of which has its advantages and disadvantages. The proper selection of the patients for each modality will result in raising the diagnostic yield of both modalities. TUS examination before medical thoracoscopy will allow proper selection of patients, reduce incidence of complications, guide for the best site of entry and raisethe diagnostic yield of medical thoracoscopy.

Safety and outcome of medical thoracoscopy as diagnostic tool for pleural and pulmonary diseases

BackgroundThe accurate diagnosis of pleural effusion is challenging because even after thoracocentesis and/or closed pleural biopsy, 25–40% of pleural effusion remains undiagnosed. Thoracoscopy is now considered the approach of choice for diagnosis of certain kinds of pleural diseases such as pleural mass, malignant pleural effusion with negative pleural fluid cytology, and in the diagnosis of pleural tuberculosis. Aim of studyTo evaluate the diagnostic utility and safety of medical thoracoscopy in patients with undiagnosed exudative pleural effusion and pulmonary parenchyma lesions. MethodsThis study was conducted on 44 patients, 21 males and 23 females with age ranging between 32 and 74years (mean age 57.59±7.1years). There were 38 patients with undiagnosed exudative pleural effusion, 3 patients with multiloculated pleural effusion, 1 patient with undiagnosed pulmonary nodules and 2 patients with undiagnosed pulmonary parenchyma ground glass appearance and reticulation. There were 21 patients with co morbidities and 23 patients without co morbidities. ResultsForty four patients with undiagnosed pleural and pulmonary lesions underwent medical thoracoscopy, multiple pleural nodules were found in 24 out of 44 patients (54.54%). Pleural mass was found in 6 patients (13.63%) and pleural thickness was found in 8 patients (18.2%). Pleura loculation and adhesion was found in 3 patients (6.8%). Pulmonary nodules were found in 1 patient (2.3%). Normal thoracoscopy was found in 2 patients (4.54%) and lung biopsy was taken. As regards histopathology there were 16 patients (36.36%) diagnosed as epithelial mesothelioma, 3 patients (6.81%) diagnosed as metastatic squamous cell carcinoma, 1 patient (2.27%) diagnosed as non Hodgkin lymphoma, and 4 patients diagnosed as tuberculosis. In patients with pleural mass 3 patients (6.81%) diagnosed as sarcomatous mesothelioma and 3 patients (6.81%) diagnosed as non Hodgkin lymphoma. In 8 patients with pleural thickness, 6 patients (13.63%) diagnosed as non specific pleurisy and 2 patients (4.54%) diagnosed as tuberculosis. In 3 patients with pleural loculation they diagnosed as pleural fibrosis. One patient with pulmonary nodules (2.27%) diagnosed as small cell carcinoma. In 2 patients with normal thoracoscopy lung biopsy showed desquamative interstitial pneumonia in 1 patient (2.27%) and usual interstitial pneumonia in 1 patient (2.27%). The diagnostic yield of medical thoracoscopy was 86.4% (38 patients with definite histopathological diagnosis and 6 patients 13.6% diagnosed as non specific pleurisy). As regards thoracoscopic complications bleeding needed blood transfusion occurred in 1 patient (2.27%) with malignant mesothelioma, surgical emphysema occurred in 3 patients (1 with metastatic squamous cell carcinoma, 1 with tuberculous pleural effusion and 1 with loculated empyema), hypotension occurred in 1 patient underwent lung biopsy (desquamative interstitial pneumonia), the total thoracoscopic complications were 11.36% which was mild and statistically non significant. ConclusionMedical thoracoscopy is safe and effective for the diagnosis of benign and malignant pleural disease and pulmonary nodules.

Medical thoracoscopy: Analysis on diagnostic yield through 30 years of experience.

BACKGROUND:Medical thoracoscopy (MT) or pleuroscopy is a procedure performed to diagnose and treat malignant and benign pleural diseases. Totally 2752 pleuroscopies executed in 1984–2013 in our center were considered in this study.METHODS:A retrospective observational study was performed. Observational time was divided into six series of 5 years. We calculated MT diagnostic yield and analyzed trends of main diseases diagnosed along the time.RESULTS:Along the 30 years population became progressively older. Number of pleuroscopies firstly increased, then stabilized and decreased in the last 5 years. The overall diagnostic yield of MT was 71%, increasing from 57% to 79%. The diagnostic yield was significantly higher in the presence of monolateral pleural effusion. Cancer represented more than half of diagnosis; tuberculosis was the most common nonneoplastic disease. The frequency of all cancers, mesothelioma, and lung cancer increased through the time; tuberculosis first decreased and then increased. All specimens resulted appropriate during the last 25 years.CONCLUSION:MT has a great diagnostic yield that can be improved by practice, permitting to achieve a specific histological diagnosis in about 80% of patients. Our experience demonstrates that the accurate selection of the patients undergoing to MT is very important to reach these results.

Role of thoracoscopic pleural lavage and brush in undiagnosed exudative pleural effusion

BackgroundThe accurate diagnosis of pleural effusion remains a challenging problem even after thoracentesis and closed pleural biopsy. Medical thoracoscopy has been established to have a greater diagnostic yield in the diagnosis of exudative pleural effusion. Forceps biopsy, pleural brush and lavage could be used through medical thoracoscopy to obtain pleural specimens. ObjectiveThe aim of this study is to evaluate the role of thoracoscopic pleural lavage and brush in undiagnosed exudative pleural effusion. Patients and methodsThis prospective study was carried out on 25 patients having undiagnosed exudative pleural effusion. All patients submitted to medical thoracoscopy, where forceps biopsy, pleural brush and pleural lavage specimens were taken for all patients and sent for histopathological and cytological examination. ResultsCombined thoracoscopic pleural specimens were diagnostic in 24 patients (96%), and all of them were malignant. Forceps biopsy was positive in 23 patients (92%), while pleural brush and pleural lavage were positive in 18 patients (72%) and 15 patients (60%) respectively. Pleural brush was the only diagnostic modality in one patient. Minimal complications were recorded. ConclusionCombined thoracoscopic pleural specimens (forceps biopsy, brush and lavage) increase the diagnostic yield of medical thoracoscopy for patients with undiagnosed exudative pleural effusion than separate them. Thoracoscopic pleural brushing is a safe diagnostic technique as it can brush certain dangerous areas of the pleura. Pleural lavage is more diagnostic than the initial thoracentesis.

Effectiveness of medical thoracoscopy and thoracoscopic talc poudrage in patients with exudative pleural effusion.

This study aimed to assess the effectiveness of medical thoracoscopy (MT) and thoracoscopic talc poudrage (TTP) in patients with exudative pleural effusion. We evaluated the diagnostic yields, complications and outcomes of MT and TTP in 41 consecutive patients with symptomatic pleural effusions who were planned to undergo both procedures from 1 December 2011 to 30 November 2012. Data was reviewed retrospectively and prospectively up to March 2013. Among the 41 patients, 36 underwent MT with the intent of biopsy and talc pleurodesis, 2 underwent MT for pleurodesis only and 3 had failed MT. Aetiologies of pleural effusion included lung cancer (n = 14), tuberculosis (n = 9), breast cancer (n = 7), ovarian cancer (n = 2), malignant mesothelioma (n = 1), congestive cardiac failure (n = 1), peritoneal dialysis (n = 1) and hepatic hydrothorax (n = 1); pleural effusion was undiagnosed in five patients. The overall diagnostic yield of MT, and the yield in tubercular and malignant pleural effusions were 77.8%, 100.0% and 82.6%, respectively; it was inconclusive in 22.2%. Complications that occurred were self-limiting, with no procedure-related mortality. The 30-day mortality rate was 17.1%. A total of 15 patients underwent TTP. The 30-, 60- and 90-day success rates were 77.8%, 80.0% and 80.0%, respectively, with one patient having complications (i.e. empyema). The 30-day mortality was 40.0%. MT is a safe procedure with high diagnostic yields in undiagnosed pleural effusions. TTP is an effective method to stop recurrence of pleural effusions.

Diagnostic yield of medical thoracoscopy in diagnosis of exudative pleural effusion: One year prospective study

BackgroundDifferential diagnosis of pleural disease is often a lengthy process fraught with pitfalls. Contrary to thoracocentesis and closed pleural biopsy, thoracoscopy permits biopsy with direct visualization. Medical thoracoscopy increases the diagnostic yield in patients with pleural disease when thoracocentesis and closed pleural biopsy are non diagnostic. Aim of the workThis study investigated diagnostic yield of medical thoracoscopy for undiagnosed exudative pleural effusions over one year period. Patient and MethodsThis study included 117 patients with undiagnosed exudative pleural effusions. All patients were subjected to written informed consent, full history taking, clinical examination, plain chest X-ray, CT chest and tuberculin skin test. Diagnostic pleural aspiration was done with pleural fluid chemical and cytological analysis. Patients with unhelpful pleural fluid analysis underwent medical thoracoscopy. ResultsRegarding thoracoscopic pleural biopsy histopathology, out of 117 patients, 55 were diagnosed as malignant pleural mesothelioma, 26 diagnosed as metastatic adenocarcinoma, 1 diagnosed as spindle cell carcinoma, 5 diagnosed as lymphoma, 5 diagnosed as tuberculosis, 1 diagnosed as SLE, 2 diagnosed as sarcoidosis, 6 diagnosed as empyema and 16 diagnosed as chronic non specific pleurisy. There was a statistically significant difference between the histopathological subgroups as regards mean value of age and smoking prevalence but there was no statistically significant difference as regards sex. Regarding pleural fluid cytological analysis, 5 cases were positive for malignant cells and 7 cases showed atypical mesothelial cells. Overall complication rate after medical thoracoscopy was low with no reported mortality or major complications. ConclusionMedical Thoracoscopy is a valuable diagnostic tool for undiagnosed exudative pleural effusion. It is a simple and safe procedure with low complication rate.

Diagnostic yield of medical thoracoscopy in cases of undiagnosed pleural effusion in Kobri El-Kobba Military Hospital

BackgroundRecurrent and persistent pleural exudates are common in clinical practice, and in a large number of patients, thoracocentesis and blind pleural biopsy procedures do not provide a definitive diagnosis. In the Western world, the majority of these exudates are malignant. Thoracoscopy today remains the gold standard technique in providing diagnosis and management in these cases. ObjectivesDiagnostic yield of medical thoracoscopy was evaluated in cases of undiagnosed pleural effusion. Patients and methodsSemi flexible medical thoracoscopy was done for 40 patients in the period between March 2010 and October 2012 in Kobri El-Kobba Military chest Hospital through double points of entry. ResultsMedical thoracoscopy gave a definitive diagnosis in 38 out of 40 patients with diagnostic yield 95%. Malignancy was diagnosed in 28 patients (70%), one patient was diagnosed as empyema (2.5%), tuberculosis was found in 9 patients (22.5%), and it was non diagnostic in 2 patients (5%). The post-thoracoscopic complications in the studied group have occurred only in 4 patients (10%). ConclusionMedical thoracoscopy is a valuable tool in the diagnosis of undiagnosed exudative pleural effusion. It is a simple and safe method with high diagnostic yield and with low complication rates.

Medical thoracoscopy

The technique and clinical applications of medical thoracoscopy have substantially evolved in the last few decades. The recent development of a semirigid thoracoscope, which is handled similarly to a bronchoscope, has made this procedure more attractive to pulmonologists. We will review the latest data on clinical applications, recently developed techniques, and safety of medical thoracoscopy, focusing mainly on its role in thoracic malignancies. Recent data confirm the high diagnostic yield of medical thoracoscopy - both with rigid and semirigid instruments - in detecting pleural metastases and determining the origin of pleural effusions. The degree of pleural adhesions found during thoracoscopy has been proposed by some authors as a prognostic factor for survival in patients with malignant pleural effusion. A large prospective multicenter study has established the safety of talc poudrage with large-particle talc, showing no cases of acute respiratory distress syndrome. Medical thoracoscopy is an excellent tool to establish diagnosis in patients with exudative pleural effusion of unclear origin. It is highly valuable in clarifying the origin of pleural effusions in patients with lung cancer, as the presence of a malignant pleural effusion is associated with poor survival and precludes the possibility of treatment with curative intention. Pleurodesis with talc poudrage is efficacious and well tolerated, especially with the use of large-particle talc.

The Long-term Prognosis of Patients With the Diagnosis of Nonmalignant Pleural Effusions After Pleuroscopy

Several studies have demonstrated the diagnostic yield of medical thoracoscopy (pleuroscopy) in making the diagnosis of malignant pleural effusion (MPE). No previous studies, however, have reported long-term outcomes for patients undergoing diagnostic pleuroscopy in whom no malignancy was demonstrated either with cytologic examination of pleural fluid or pathologic examination of thoracoscope-guided pleural biopsies. We report the results of long-term follow-up (at least 3 y) of patients with the diagnosis of nonmalignant pleural effusions (NMPEs) after pleuroscopy. One hundred and nineteen patients underwent the procedure between 1994 and 2003 at Lahey Clinic. We report a retrospective review of 25 of those patients diagnosed with NMPE after diagnostic pleuroscopy. All 25 patients underwent thoracoscopic pleural biopsy and cytologic examination of the effusion. Outcomes were assessed using review of the medical records, appointment scheduler, social security death index, and/or telephone conversation with primary care providers. Mean age±SD was 68 years (range, 34 to 87 y). Median survival time was estimated at 114 months. Concomitant illness was also evaluated: 40% (n=10) diabetes, 64% (n=16) coronary artery disease, 40% (n=10) congestive heart failure, 20% (n=5) liver disease, 20% (n=5) renal disease, and 36% (n=9) pulmonary disease. Final diagnoses after pleuroscopy most commonly included chronic pleuritis (n=7) and pleural plaques (n=5). Survival was found at 1 year to be 88% (22/25), 3 years 80% (20/25), and 5 years 74.7% (19/25). None of the 25 patients developed subsequent MPE. Patients with NMPE after pleuroscopy have a favorable prognosis and are unlikely to be subsequently diagnosed with an MPE.

THE LONG-TERM PROGNOSIS OF PATIENTS WITH THE DIAGNOSIS OF NONMALIGNANT PLEURAL EFFUSIONS AFTER PLEUROSCOPY

Purpose Several studies have demonstrated the diagnostic yield of medical thoracoscopy (pleuroscopy) in making the diagnosis of malignant pleural effusion (MPE). No previous studies, however, have reported long-term outcomes for patients undergoing diagnostic pleuroscopy in whom no malignancy was demonstrated either with cytologic examination of pleural fluid or pathologic examination of thoracoscope-guided pleural biopsies. We report the results of long-term follow-up (at least 3 y) of patients with the diagnosis of nonmalignant pleural effusions (NMPEs) after pleuroscopy. Methods One hundred and nineteen patients underwent the procedure between 1994 and 2003 at Lahey Clinic. We report a retrospective review of 25 of those patients diagnosed with NMPE after diagnostic pleuroscopy. All 25 patients underwent thoracoscopic pleural biopsy and cytologic examination of the effusion. Outcomes were assessed using review of the medical records, appointment scheduler, social security death index, and/or telephone conversation with primary care providers. Results Mean age±SD was 68 years (range, 34 to 87 y). Median survival time was estimated at 114 months. Concomitant illness was also evaluated: 40% (n=10) diabetes, 64% (n=16) coronary artery disease, 40% (n=10) congestive heart failure, 20% (n=5) liver disease, 20% (n=5) renal disease, and 36% (n=9) pulmonary disease. Final diagnoses after pleuroscopy most commonly included chronic pleuritis (n=7) and pleural plaques (n=5). Survival was found at 1 year to be 88% (22/25), 3 years 80% (20/25), and 5 years 74.7% (19/25). None of the 25 patients developed subsequent MPE. Conclusions Patients with NMPE after pleuroscopy have a favorable prognosis and are unlikely to be subsequently diagnosed with an MPE.