Safety Of Medical Thoracoscopy Research Articles

Diagnostic value and safety of medical thoracoscopy in undiagnosed pleural effusions-a prospective observational cohort study.

With the need for "actionable histology" in the current era of targeted cancer treatment, and the increasing practice of upfront thoracoscopy (without a prior diagnostic thoracentesis) or a "biopsy first" approach in suspected malignant pleural effusions (MPEs), we sought to prospectively evaluate the diagnostic accuracy, including full molecular profiling of cancer, and safety of medical thoracoscopy (MT) at a tertiary referral hospital. Patients with MT performed for an undiagnosed pleural effusion between January 2020 and December 2022 were included in this observational cohort study. All procedures were performed with a semirigid thoracoscope under conscious sedation. Clinical outcomes and adverse events were recorded prospectively. We evaluated 141 patients, with a mean age of 67±12 years. Talc poudrage was performed in 67 (47.5%) patients with a median of 2 [interquartile range (IQR), 1-4] hospitalisation days after MT. Upfront thoracoscopy was performed in approximately half (55.3%) of patients. The overall diagnostic accuracy of MT was 95.7% in our cohort. A final diagnosis of cancer was made in 116 (82.3%) patients, with lung (67.2%) and breast cancer (8.6%) the most common. The diagnostic sensitivity of MT for malignancy was 94.8%, and molecular profiling of relevant cancer types for oncogenic mutations was achieved in all patients with malignancy seen on histopathology. The most common non-malignant diagnosis was tuberculous pleuritis in 14 patients (9.9%). Major complications occurred in 3 (2.1%) patients. Two patients had re-expansion pulmonary edema that resolved with low flow oxygen supplementation in the general ward, and one patient required intensive care unit admission for cardiac tamponade from a malignant pericardial effusion. There were no cases of mortality, bleeding complications or persistent air leaks. MT is a well-tolerated and effective option for the evaluation of undiagnosed pleural effusions. With expanding utility and expertise with MT and other pleural interventions, the challenge for respiratory physicians is integrating these into expeditious diagnostic and effective therapeutic pathways, individualised to patients' needs.

Medical Thoracoscopy and Intrapleural Fibrinolytic Therapy for the Management of Pleural Empyema: A Cohort Study

Background: Pleural empyema is associated with relevant morbidity and mortality, and it may be classified, according to evolution and ultrasound, into three stages: stage I (free-flowing effusion), stage II (viscous effusion with the tendency to loculate), and stage III (organizing phase). According to guidelines, antibiotic therapy and pleural drainage are recommended, with surgery being performed when patients fail and/or in case of organized empyema. Objectives: The aim of the study was to report the efficacy and safety of medical thoracoscopy in patients with pleural empyema stratified by chest ultrasound. Method: Observational retrospective cohort study analyzing patients with pleural empyema treated with medical thoracoscopy. Procedure success and mortality were evaluated at 30 days and 90 days after the procedure; complications were also reported. Results: 131 patients were included. Intrapleural fibrinolytic therapy was performed thereafter in the majority of cases. Medical thoracoscopy was considered successful without subsequent intervention in 99 patients (76%); 19 patients (15%) underwent a second procedure (drainage, thoracoscopy, video-assisted thoracic surgery, or thoracotomy); and 6 patients (5%) died of the evolution of empyema. Patients treated in stages I and II showed significantly better post-procedure results compared with patients treated in stage III (100%, 83.3%, and 58.1%, respectively). Thoracoscopy complications were observed in 18 patients and were reversible in all cases. Conclusions: Patients with pleural empyema treated in earlier stages (free-flowing or multiloculated effusion) with medical thoracoscopy show significantly better results than patients treated in later stages (organized empyema). This approach is safe, minimally invasive, and efficient in these patients with disease having relevant mortality; however, patient selection remains essential.

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.

Diagnostic value and safety of medical thoracoscopy under local anesthesia for unexplained diffuse interstitial lung disease: A retrospective study.

ObjectiveWe aimed to explore the safety and diagnostic value of medical thoracoscopic lung biopsy in patients with unexplained diffuse interstitial lung disease (ILD) in a single center pilot study.MethodWe retrospectively analyzed clinical and pathological diagnostic data from 52 patients with diffuse ILD undergoing medical thoracoscopic lung biopsy.ResultsForty-four cases of diffuse ILD were confirmed pathologically, giving a diagnostic rate of 84.6%. Among these 44 patients, 11 patients were diagnosed with cancer, including eight patients with lung adenocarcinoma, three patients with metastases; two from a gastrointestinal malignancy, and one from a granulosa cell tumor of the ovary. There were 17 cases of idiopathic interstitial pneumonia, including nine cases of usual interstitial pneumonia (UIP), four cases of non-specific interstitial pneumonia (NSIP), three cases of cryptogenic organizing pneumonia (COP), and one case of acute interstitial pneumonia (AIP). There were 12 cases of rare interstitial pneumonias, which included six cases of pulmonary alveolar proteinosis, one case each of pulmonary Langerhans cell histiocytosis (LCH) and pulmonary lymphangiomyomatosis, two cases of nodular sarcoidosis, and two cases of chronic eosinophilic pneumonia. We recorded various complications, including bleeding, infection, and pneumothorax. A total of 28 patients (53.8%) experienced at least one of the above complications, but there were no deaths associated with biopsy.ConclusionsMedical thoracoscopic lung biopsy appears a safe and effective method for diagnosing diffuse ILD of unknown cause but further prospective studies, with larger numbers, including comparison with other established techniques are required.

Medical Thoracoscopy for Undiagnosed Exudative Pleural Effusion: A Descriptive Cross-sectional Study.

Medical thoracoscopy has recently gained renewed interest due to its minimal invasive nature and high yield diagnostic outcome. This study aims to observe diagnostic yield and safety of medical thoracoscopy in undiagnosed exudative pleural effusion. This is a descriptive cross-sectional study conducted in two tertiary care hospitals in Chitwan from March 2018 to May 2018. Ethical approval from the Institutional Review Board was obtained. Convenient sampling was done that included all the patients who met criteria for undiagnosed exudative pleural effusion after diagnostic thoracocentesis. Patients having contraindication to procedure and who refused consent were excluded. Statistical analysis was performed using IBM SPSS Statistics 20 and data are presented as mean±SD and frequency (percentage). A total of 14 patients underwent rigid medical thoracoscopy. All 14 patients had unilateral pleural effusion. The overall diagnostic yield was 100%. Malignancy was the most frequent histopathology diagnosis seen in 11 (78.57%) patients, the commonest being metastatic adenocarcinoma in 8 (57.1%). Pleural tuberculosis and acute-on-chronic pleuritis were seen in 2 (14.3%) and 1 (7.1%) patients, respectively. Pleural deposits and hemorrhagic pleural fluid were the two commonest findings, seen in 10 (70.1%) and 9 (64.3%) patients, respectively. Two (14.3%) patients clinically treated as tuberculous pleural effusion was re-diagnosed to have metastatic adenocarcinoma. Common procedure-related minor complications observed were mild to moderate pain and mild bleeding, observed in 3 (21.4%) and 2 (14.3%) patients, respectively. Medical thoracoscopy is a safe, well-tolerated and high yield procedure in undiagnosed exudative pleural effusion. This art of medicine should be promoted in daily medical practice.

Safety and complications of medical thoracoscopy in the management of\xa0pleural diseases

BackgroundMedical thoracoscopy is considered an overall safe procedure, whereas numbers of studies focus on complications of diagnostic thoracoscopy and talc poudrage pleurodesis. We conduct this study to evaluate the safety of medical thoracoscopy in the management of pleural diseases and to compare complications in different therapeutic thoracoscopic procedures.MethodsA retrospective study was performed in 1926 patients, 662 of whom underwent medical thoracoscopy for diagnosis and 1264 of whom for therapeutic interventions of pleural diseases. Data on complications were obtained from the patients, notes on computer system, laboratory and radiographic findings. Chi-square test was performed to compare categorical variables and Fisher’s exact test was used for small samples.ResultsThe mean age was 51 ± 8.4 (range 21–86) years and 1117 (58%) were males. Diagnostic procedure was taken in 662 (34.4%) patients, whereas therapeutic procedure was taken in 1264 (65.6%) patients. Malignant histology was reported in 860 (44.6%) and 986 (51.2%) revealed benign pleural diseases. Eighty patients (4.2%) were not definitely diagnosed and they were considered as unidentified pleural effusion. One patient died during the creation of artificial pneumothorax, and the causes of death were supposed as air embolism or an inhibition of phrenic motoneurons and circulatory system. Complication of lung laceration was found in six patients (0.3%) and reexpansion pulmonary edema was observed in two patients (0.1%). Higher incidence of prolonged air leak was observed in bulla electrocoagulation group, in comparison with pleurodesis group. Moreover, pain and fever were the most frequently complications in pleurodesis group and cutaneous infection in entry site was the most frequently reported complication in pleural decortication of empyema group.ConclusionsMedical thoracoscopy is generally a safe and effective method, not only in the diagnosis of undiagnosed pleural effusions, but also in the management of pleural diseases. Mastering medical thoracoscopy well, improving patient management after the procedure and attempts to reduce the occurrence of post-procedural complications are the targets that physicians are supposed to achieve in the future.

Awake sedation thoracoscopy for the diagnosis of malignant mesothelioma: a service review

Abstract Background Mortality from malignant mesothelioma is expected to peak in the UK in the current decade. Areas of the country which have historically high rates of industrial exposure to asbestos, such as South East Wales, are expected to bear a disproportionately high burden of mesothelioma, making a priority. Medical thoracoscopy is an effective and safe procedure, affording both a high diagnostic yield in mesothelioma and an opportunity to carry out therapeutic drainage of pleural effusion. Methods We evaluated the diagnostic yield and safety of medical thoracoscopy at our centre over a 5-year period from 2010 to 2015 including 104 consecutive patients. Results We found that thoracoscopy provided a conclusive result effected 91.6% of successful biopsies. Thoracoscopy was especially superior to pleural cytology in the diagnosis of malignant mesothelioma, revealing 37 cases when cytology suggested only 5. The procedure was particularly safe with no mortality and only 6.7% of patients experiencing minor complications such as hypotension, and more than 75% of patients tolerated the procedure with mild or no discomfort. Conclusion We conclude that the awake sedation thoracoscopy service at our institution is safe and effective, particularly in the diagnosis of mesothelioma, which is common in our area.

The role of medical thoracoscopy in the management of empyema

BackgroundEmpyema thoracis is defined as accumulation of pus in the pleural space. Despite advanced medical diagnostic and therapeutic methods, thoracic empyema remains a common clinical entity and a serious problem all over the world with significant associated morbidity and mortality.AimThe aim of this work was to study the efficacy and safety of medical thoracoscopy (MT) in the management of empyema.Patients and methodsThis study included 30 inpatients with empyema. Included patients had frank pus on aspiration (turbid purulent fetid fluid) with or without positive Gram stain smear and microbiological culture findings or pH less than 7.20, with signs of sepsis. Patients were managed by MT. MT using rigid thoracoscopy was performed with evacuation of the purulent fluid, visualization of the pleural space, assessment of adhesions and purulent material, forceps adhesiolysis, and irrigation by normal saline with partial debridement of accessible parietal pleural surface.ResultsThe present study included 30 patients with empyema (17 men, 13 women with a mean age of 47.4±14.5 years; range, 18–70 years); 19 (63.3%) patients had free-flowing empyema (by computed tomography/ ultrasonography) and 11 (36.7%) patients had multiloculated empyema. The etiology of empyema included pneumonia (parapneumonic effusion) (33.3%), malignancy (23.3%), tuberculosis (6.7%), lung abscess (6.7%), and no cause was identified in nine patients (spontaneous pleural infection) (30%). MT was considered successful without subsequent interventional procedures in 26 of 30 (86.7%) patients, including all patients with free-flowing empyema (19 patients), 63.6% of patients with multiloculated empyema (seven patients), and four (13.3%) patients required surgical intervention (surgical decortication). No procedure-related mortality or chronic morbidity occurred in this study.ConclusionMT is a simple, safe, minimally invasive, and effective modality in the management of empyema.

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.

Diagnostic Value and Safety of Medical Thoracoscopy in the Management of Exudative Pleural Effusion

Diagnostic Value and Safety of Medical Thoracoscopy in the Management of Exudative Pleural Effusion

P1.04-021 Medical Thoracoscopy for the Diagnosis and Management of Pleural Effusions: Results of a Retrospective Analysis

Medical thoracoscopy is a minimally invasive procedure utilized mainly by pulmonologists for the diagnosis and management of pleural effusions. The aim of this study was to evaluate the efficacy and safety of medical thoracoscopy when performed by a combined team of pulmonologists and thoracic surgeons in a tertiary university hospital. This is a retrospective cohort analysis of all patients with pleural effusion whο underwent medical thoracoscopy at “LAIKO” Athens General Hospital from June 2013 to December 2014. Our study population included 36 patients, 18 males and 18 females, with a mean age of 61 years. All patients were submitted to medical thoracoscopy for the diagnostic evaluation of pleural effusion. Twenty-six patients (26/36, 72.2%) presented with an undiagnosed pleural effusion, six (16.7%) with known malignant, recurrent pleural effusion, three (8.3%) with parapneumonic effusion/empyema and one (2.8%) with idiopathic pleural effusion due to nephritic syndrome. Eighteen patients (18/36, 50%) underwent drainage and pleural biopsy, 9 patients (9/36, 25%) underwent drainage, pleural biopsy and talc pleurodesis, 6 patients (6/36, 16.7%) underwent drainage and talc pleurodesis due to known malignant pleural effusion and 3 patients (3/36, 8.3%) underwent drainage of their parapneumonic effusion/empyema. Among all patients (n=27) who underwent diagnostic pleural biopsy, 2 patients (7.4%) were diagnosed with primary non-small cell lung cancer, 4 (14.8%) with malignant pleural mesothelioma, 3 (11.1%) with metastatic disease of non-thoracic primary origin and 3 (11.1%) with lymphoma, while 1 patient each (3.7%) was diagnosed with tuberculosis, systemic lupus eryhtematosus, chronic inflammation, chronic pleural fibrosis and nephritic syndrome. In 3 patients (3/27, 11.1%) the biopsy was negative. Medical thoracoscopy was non-diagnostic in one patient only (1/27, 3.7%), thus producing a diagnostic yield of 97.3%. With the notable exception of one patient (1/36, 2.8%) who died due to empyema and subsequent sepsis, the remaining post procedural complications were mild, and included subcutaneous emphysema in 6 cases (6/36, 16.7%) and minor bleeding in 3 cases (3/36, 8.3%). When performed by a combined team of pulmonologists and thoracic surgeons in a tertiary level hospital, medical thoracoscopy is a relatively safe and efficacious technique for the diagnosis and management of pleural effusions in patients unable to undergo or not requiring surgical intervention.

The Safety of Medical Thoracoscopy in a Community Based Interventional Pulmonology Fellowship Program

The Safety of Medical Thoracoscopy in a Community Based Interventional Pulmonology Fellowship Program

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.

Efficacy and Safety of Diagnostic Thoracoscopy in Undiagnosed Pleural Effusions

Background: The differential diagnosis of pleural effusions can present a considerable challenge, and the etiology of pleural effusions varies depending on the population studied. Objective: This study aimed to assess the efficacy and safety of medical thoracoscopy in the diagnosis of patients with undiagnosed pleural effusions in a Chinese population. Methods: Between July 2005 and June 2014, medical thoracoscopy (MT) using the semirigid instrument was performed in 833 patients with pleural effusions of unknown etiology in our Institute, where diagnostic thoracocentesis or/and blind pleural biopsy had failed to yield an answer. Demographic, radiographic, procedural, and histological data were recorded and analyzed. Results: During this 9-year study, satisfactory pleural biopsy samples were obtained in 833 patients, and MT revealed malignant pleural effusion in 342 (41.1%) patients, benign pleural effusion in 429 (51.5%) patients, and 62 (7.4%) patients could not get definite diagnoses. The overall diagnostic efficiency of MT was 92.6% (771/833). After MT, the only severe complication was empyema, seen in 3 patients (0.4%). The most common minor complication was transient chest pain (44.1%) from the indwelling chest tube. Conclusions: MT is an effective and safe procedure for diagnosing pleural effusions of undetermined causes. In areas with high tuberculosis prevalence, MT should be particularly helpful in the differential diagnosis of tuberculous pleural effusion.

Diagnostic value and safety of medical thoracoscopy in tuberculous pleural effusion

BackgroundDifferentiating tuberculous pleural effusion from other lymphocytic pleural effusions is often challenging. This retrospective study aimed to assess the efficacy and safety of medical thoracoscopy in patients with suspected tuberculous pleural effusion. MethodsBetween July 2005 and June 2014, patients with pleural effusions of unknown etiologies underwent medical thoracoscopy in our institute after less invasive means of diagnosis had failed. Demographic, radiographic, procedural, and histological data of patients with tuberculous pleural effusion were analyzed. ResultsDuring this 9-year study, 333 of 833 patients with pleural effusion were confirmed to have tuberculous pleurisy. Under thoracoscopy, we observed pleural nodules in 69.4%, pleural adhesion in 66.7%, hyperemia in 60.7%, plaque-like lesions in 6.0%, ulceration in 1.5% of patients with tuberculous pleurisy. Pleural biopsy revealed the presence of Mycobacterium tuberculosis in the pleural tissue or/and demonstration of caseating granulomas in 330 (99.1%) patients. No serious adverse events were recorded, and the most common minor complication was transient chest pain (43.2%) from the indwelling chest tube. ConclusionsOur data showed that medical thoracoscopy is a simple procedure with high diagnostic yield and excellent safety for the diagnosis of tuberculous pleural effusion.

Feasibility and Safety of Medical Thoracoscopy: A Single Institution Experience

Feasibility and Safety of Medical Thoracoscopy: A Single Institution Experience

Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions in Denmark.

To assess the diagnostic accuracy and the safety of medical thoracoscopy (MT) performed with the semirigid thoracoscope. We retrospectively evaluated patients who underwent MT with semirigid thoracoscope under local anesthesia for unexplained exudative pleural effusion from March 1, 2009 to September 1, 2013 in Denmark. Sixty-nine patients were retrospectively studied. In 13 patients it was not possible to perform the scheduled MT, in 9 cases due to an insufficient pneumothorax, in 3 due to an insufficient pleural effusion, and in 1 due to a purulent pleuritis. In 56 patients in whom MT was completed, the procedure was diagnostic in 44 cases: malignancy was reported in 26 patients and a benign diagnosis in 18. In the remaining 12 patients a definite diagnosis was not reached, and further testing was required.In an "intention-to-treat analysis" (69 patients in total), the diagnostic accuracy of MT was 63%, the sensitivity for malignancy was 59% [95% confidence interval (CI)=43%-73%], the specificity was 100% (95% CI=86%-100%), and the negative likelihood ratio was 0.41 (95% CI=0.29-0.58). Considering the 56 patients in whom it was possible to complete the procedure, the diagnostic accuracy was 78%, the sensitivity for malignancy was 74% (95% CI=54%-87%), the specificity was 100% (95% CI=83.75%-100%), and the negative likelihood ratio was 0.27 (95% CI=0.15%-0.45%). No mortality was reported. MT performed under local anesthesia with a semirigid scope is a simple and safe procedure with an acceptable sensitivity for malignancy.

The Safety of Medical Thoracoscopy in a Group at High Risk for Complications

The use of medical thoracoscopy (MT) for the diagnosis and/or palliative treatment of pleural effusions is expected to become more widespread in the coming years. The aims of the present study were to establish the safety of MT in a group of patients at high risk for complications and to determine the factors that affect the development of complications. A total of 355 patients who underwent MT were divided into 2 groups: patients at high risk for complications and patients who had no risk factor. After the procedure, the complications of MT were recorded. All patients were followed up for at least 24 months. To evaluate the relationship between variables and complications, logistic regression models were applied. Of the 355 patients, 106 had one or more risk factors, whereas 249 did not have any risk factor. Pain (12.3%) was the most frequent complication in the high-risk patients, and subcutaneous emphysema (10.3%) was the most frequently reported complication in the normal-risk patients. Only pain was observed more frequently in the high-risk patients compared with the normal-risk patients. Talc pleurodesis was associated with prolonged air leak (8.3%) and empyema (5%). The percentage of patients with no complication was 58.6%. The mortality rate was 0.28%. In the multivariate analysis, the presence of mesothelioma was identified as a factor that increased the risk of complication. MT is a safe method for the diagnosis of patients with pleural effusion, even in patients at high risk for complications. However, complications, found in approximately half of the patients, should also be examined in terms of cost.

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.

Diagnostic Accuracy and Safety of Medical Thoracoscopy

Background: The causes of the pleural effusion are remained unclear in a the substantial number of patients with exudative effusions determined by an examination of the fluid obtained via thoracentesis. Among the various tools for diagnosing exudative pleural effusions, thoracoscopy has a high diagnostic yield for cancer and tuberculosis. Medical thoracoscopy can also be carried out under local anesthesia with mild sedation. The aim of this study was to determine diagnostic accuracy and safety of medical thoracoscopy. Methods: Twenty-five patients with exudative pleural effusions of an unknown cause underwent medical thoracoscopy between October 2005 and September 2006 in Konyang University Hospital. The clinical data such as age, gender, preoperative pulmonary function, amounts of pleural effusion on lateral decubitus radiography were collected. The vital signs were recorded, and arterial blood gas analyses were performed five times during medical thoracoscopy in order to evaluate the cardiopulmonary status and acid-base changes. Results: The mean age of the patients was 56.8 years (range 22-79). The mean depth of the effusion on lateral decubitus radiography (LDR) was 27.49 mm. The medical thoracoscopic pleural biopsy was diagnostic in 24 patients (96.0%), with a diagnosis of tuberculosis pleurisy in 9 patients (36%), malignant effusions in 8 patients (32%), and parapneumonic effusions in 7 patients (28%). Medical thoracoscopy failed to confirm the cause of the pleural effusion in one patient, who was diagnosed with tuberculosis by a pericardial biopsy. There were no significant changes in blood pressure, heart rate, acid-base and no major complications in all cases during medical thoracoscopy (p>0.05). Conclusions: Medical thoracoscopy is a safe method for patients with unknown pleural effusions with a relatively high diagnostic accuracy.