Thoracoscopic Biopsy Research Articles

A case report of mediastinal extramedullary hematopoiesis: imaging, pathological and thoracoscopic biopsy correlation

ObjectiveTo summarize the clinical features, imaging characteristics, and surgical diagnosis and treatment experience of mediastinal extramedullary hematopoiesis.MethodsBy summarizing and analyzing the case data and reviewing the literature, one case of posterior mediastinal extramedullary hematopoiesis on thoracoscopic biopsy in our department was summarized.ConclusionPosterior mediastinal extramedullary hematopoiesis is a response to failure of bone marrow erythropoiesis, which is relatively rare clinically, and diagnosis requires a combination of patient history and imaging, puncture biopsy or thoracoscopic excisional biopsy can provide a pathological diagnosis, and surgical complete resection is the main treatment modality.

Diagnosis of pleural tuberculosis in the era of thoracoscopic surgery

Background Before thoracoscopic surgery, diagnosing tuberculous (TB) pleurisy was a medical challenge. Thoracoscopy is the most accurate but expensive method for TB pleurisy diagnosis. TB is common in low-income countries, where financial limitations prevent the use of thoracoscopy, motivating the search for a cheaper alternative. Patients and methods A prospective study was done from January 2019 to January 2023 to evaluate diagnostic methods for patients with exudative pleural effusions (PE) of unknown etiologies. The demographic, radiological, procedural, and histological data of exudative PE patients were analyzed. All patients were examined for adenosine deaminase (ADA) and lymphocyte/neutrophil ratio in pleural fluid. Ultrasound-guided Abrams needle biopsy and video-assisted thoracoscopic surgery pleural biopsies were obtained, and histopathological results were assessed. Results Of 250 patients with PE, 161 (64%) had TB PE, 72 (28.8%) had malignant PE, and 17 (6.8%) had idiopathic PE. Sensitivity of ADA (≥40 U/l) was 88%, lymphocyte/neutrophil ratio (≥0.75) was 86.1%, and their overall sensitivity was 91%. They had 93.2, 86.3, and 100% specificity, respectively. For ultrasound-guided Abrams needle biopsy, the sensitivity of histopathology, culture, and combined histopathology/culture was 66, 46.5, and 78.4%, respectively. All were 100% specific. For thoracoscopic biopsy, the sensitivity of histopathology, culture, and combined histopathology/culture was 100, 86.6, and 100%, respectively. All were 100% specific. The assay sensitivity of pleural fluid and tissue Xpert Mycobacterium tuberculosis/rifampin resistance was 12.5 and 49.7%, respectively. Both were 100% specific. Combining ADA more than or equal to 40 U/l, lymphocyte/neutrophil ratio more than or equal to 0.75, and an ultrasound-guided Abrams needle biopsy yielded 92.4% sensitivity and 100% specificity. Conclusion Combining pleural fluid ADA more than or equal to 40 U/l, lymphocyte/neutrophil ratio more than or equal to 0.75, and ultrasound-guided Abrams needle biopsy can accurately detect TB PE in high-TB populations. It may be an affordable alternative to thoracoscopy in countries with limited resources.

The rare case of synchronous bilateral breast metastasis from a lung neuroendocrine tumor (small cell lung carcinoma): a case report and literature review

BackgroundBreast metastasis from small cell neuroendocrine carcinoma (SNEC) is very rare. In the present report, we describe a case of a female patient who was initially diagnosed with triple negative primary bilateral breast cancer, but during systemic examination, the diagnosis was bilateral breast metastasis from SNEC.Case presentationA 62-year-old woman with no history of smoking presented to the Department of General Medicine with left-sided chest pain, and computed tomography revealed masses in both breasts and left pleural thickening that was further confirmed by mammography and ultrasound of the breasts. A needle biopsy was performed, and triple negative primary bilateral breast cancer was diagnosed. Because progastrin-releasing peptide (ProGRP) 37,300 pg/ml (normal range, 0–81.0 pg/ml) and neuron-specific enolase 35.0 ng/ml (normal range, 0–16.3 ng/ml) levels were elevated, thoracoscopic biopsy was performed, and SNEC was diagnosed. Pathological examinations showed that the bilateral breast masses were also positive for immunohistochemical staining of chromogranin A, synaptophysin, and CD56, leading to a diagnosis of bilateral breast metastasis of neuroendocrine tumor.ConclusionAlthough very rare, the possibility of breast metastasis should be considered when malignancy is suspected in other organs.

Re-designing health care: transitioning thoracoscopic pleural biopsies from the operating room to the outpatient setting using simulation for training and testing

Re-designing health care: transitioning thoracoscopic pleural biopsies from the operating room to the outpatient setting using simulation for training and testing

A case of pleural metastasis of malignant peripheral nerve sheath tumor

Malignant peripheral nerve sheath tumor (MPNST) frequently metastasizes to the lungs, although pleural metastasis is rare. This article reported a case of pleural metastasis of MPNST. The patient was a young man who presented with 1 week of shortness of breath with dry cough. He had a history of malignant peripheral nerve sheath tumor. The patient was diagnosed with MPNST pleural metastasis after a thoracoscopic pleural biopsy, which revealed short spindle cell hyperplasia, immunohistochemical staining for S-100(+), SOX-10(+), Ki-67(+) with a positive index of 20%, and H3K27Me3(-) in the pleural pathology.

Assessing Lung Fibrosis with ML-Assisted Minimally Invasive OCT Imaging.

This paper presents a combined optical coherence tomography (OCT) imaging/machine learning (ML) technique for real-time analysis of lung tissue morphology to determine the presence and level of invasiveness of idiopathic lung fibrosis (ILF). This is an important clinical problem as misdiagnosis is common, resulting in patient exposure to costly and invasive procedures and substantial use of healthcare resources. Therefore, biopsy is needed to confirm or rule out radiological findings. Videoscopic-assisted thoracoscopic wedge biopsy (VATS) under general anesthesia is typically necessary to obtain enough tissue to make an accurate diagnosis. This kind of biopsy involves the placement of several tubes through the chest wall, one of which is used to cut off a piece of lung to send for evaluation. The removed tissue is examined histopathologically by microscopy to confirm the presence and the pattern of fibrosis. However, VATS pulmonary biopsy can have multiple side effects, including inflammation, tissue morbidity, and severe bleeding, which further degrade the quality of life for the patient. Furthermore, the results are not immediately available, requiring tissue processing and analysis. Here, we report an initial attempt of using ML-assisted polarization sensitive OCT (PS-OCT) imaging for lung fibrosis assessment. This approach has been preliminarily tested on a rat model of lung fibrosis. Our preliminary results show that ML-assisted PS-OCT imaging can detect the presence of ILF with an average of 77% accuracy and 89% specificity.

Adaptively learning visual model of surgical resection images via coarse-to-fine–grained strategy for pathological invasiveness prediction in indeterminate stage IA lung adenocarcinoma.

1563 Background: Indeterminate nodules with high risk of malignancy are suggested to receive video-assisted thoracoscopy biopsy. Frozen section assists surgeons to decide surgical strategies for stage IA lung adenocarcinoma (LUAD) intraoperatively, which is time-consuming and may misdiagnosis due to limited sampling and poor tissue quality. Methods: We prospectively enrolled stage IA LUAD patients underwent complete resection between June 2020 and September 2023 in Guangdong Provincial People's Hospital (GDPH), Affiliated Hospital of Guangdong Medical University, Meizhou People's Hospital. All the resected lung nodules were finally diagnosed as pre-invasive lesion (PIL), minimally invasive adenocarcinoma (MIA) or invasive lung adenocarcinoma (IAC) by FFPE pathological diagnosis. Images of the whole section of the lung nodules were taken by smartphones under natural lighting condition in operating theaters without shadowless surgical lights. Patients received preoperative anti-cancer therapy and with low-quality tumor section images were excluded. Images of nodules section, FS reports, FFPE diagnosis and clinical information were prospectively collected. Predictive artificial intelligence (AI) model was developed by a three-step process, which first predict the IAC and non-IAC region at coarse level, and identify fine level features through the high-risk region. The coarse and fine labels were then coordinated through risk ranking loss to reach a final predictive result. Results: We prospectively enrolled 1516 patients with 1638 indetermined lung nodules from preoperative chest CT following the inclusion and exclusion criteria, with 2438 images acquired from intraoperative nodule sections. The included patients have median age of 57 years old and 38.6% male patients. The pathological diagnosis for included lung nodules are 122 PIL nodules, 502 MIA nodules and 1014 stage IA LUAD. A multi-task artificial intelligence based on Coarse-to-Fine-Grained Strategy has been established to classify the indetermined lung nodules during the surgery. For binary classification, AI model reach an AUC of 0.86 in differentiation between IAC or non-IAC. For 3-classification level, AI model reach an AUC of 0.87 in differentiation between PIL, MIA or IAC. We further defined the IAC nodules into G1, G2 and G3 according to IASLC lung adenocarcinoma grading system. For 5-classification level, AI model reach an AUC of 0.86 in differentiation between PIL, MIA, IAC-G1, IAC-G2 and IAC-G3. Conclusions: Our AI models based on images of intraoperative surgical resection could effectively classify indetermined lung nodules, which can assist thoracic surgeons diagnose the nodules rapidly during the surging and decide the following surgical strategies. Clinical trial information: ChiCTR2300075999 .

Thoracic Endometriosis Detected During Medical Thoracoscopy in a Tertiary Care Setting - A Retrospective Observational Study

Background: Thoracic endometriosis is a very rare clinical situation mostly presenting with pleural diseases, that is often misdiagnosed or missed due to the lack of specific clinical features. This report aims to explore the clinical characteristics, thoracoscopic findings, histopathology, treatment, and prognosis of women with thoracic endometriosis, providing a reference for the diagnosis and management of thoracic endometriosis. Design/Methods: Clinical data of 3 patients diagnosed with pleural endometriosis from among 50 consecutive thoracoscopic procedures conducted in a tertiary care hospital in North Kerala were analysed from electronic hospital records. The clinical features, thoracoscopic findings, histopathological features, treatment process, and prognosis were summarized. Results: Among the 3 female patients with pleural endometriosis, there were 2 cases of catamenial pneumothorax and one case of catamenial haemothorax. The age ranged from 43 years to 44 years. All the 3 cases were diagnosed by thoracoscopic pleural biopsy. Conclusions: Thoracic endometriosis syndrome is extremely rare, and clinical diagnosis is always missed or delayed due to nonspecific symptoms. Diagnosis mainly relies on pathological findings and immunohistochemical detection. Most cases were managed conservatively with hormonal therapy or by inducing surgical menopause.

A Rare Case of Tuberculous Constrictive Pericarditis Due to Disseminated Tuberculosis with Response to Anti-tuberculosis Chemotherapy and Steroids in a Developed City State

A 27-year-old man presented with a 1-week history of atypical chest pain and sinus tachycardia. His physical examination was unremarkable. His resting ECG showed sinus tachycardia with widespread T-wave inversion. His initial blood tests show mildly raised troponin T and inflammatory markers and marked raised D-dimer. A CT pulmonary angiogram was performed to exclude pulmonary embolism but incidentally revealed an anterior mediastinal mass. A transthoracic echocardiogram and cardiac MRI showed features of constrictive pericarditis. A video-assisted thoracoscopic surgical biopsy of the anterior mediastinal mass showed thymic tissue with necrotising granulomatous inflammation and an acid-fast bacilli culture was positive to tuberculosis infection. The patient was started on anti-tuberculosis chemotherapy and a 6-week tapering course of oral steroids. A repeat cardiac MRI performed after 6 weeks of treatment showed a significant response to treatment with resolution of constrictive physiology.

Physician-led thoracic ultrasound-guided biopsy; a district general hospital perspective.

Physician-led thoracic ultrasound (TUS)-guided biopsies provide a prompt route to tissue diagnosis in pleural and peripheral lung malignancies. This retrospective study reviews the diagnostic performance and safety of this approach in a UK District General Hospital. Time to biopsy, diagnostic yield and complication rate were analysed in a cohort of 49 patients undergoing ultrasound-guided tissue sampling between September 2019 and December 2022. Fifty-one TUS-guided biopsies were attempted. Mean time from decision to biopsy was 5 days. The overall diagnostic yield was 82%. Complication rate was low; 3 minor adverse effects were reported which led to no change in routine care. This single centre retrospective study shows that physician-led TUS-guided biopsy provides a safe and timely method of obtaining a tissue diagnosis in thoracic malignancy. It offers an alternative to computer tomography (CT)-guided or thoracoscopic biopsies and should be considered in selected patients where local procedural expertise exists.

Eksudatif Plevral Efüzyonda Torakoskopik Biyopsinin Tanısal Rolü ve Uzun Dönem Takip Sonuçları

Giriş: Eksudatif plevral efüzyonların %20’sinde, tekrarlayan torasentez ve perkutan plevral biyopsiye rağmen tanısı konulamaz. Bu çalışmanın amacı daha az invaziv yöntemlerle tanısı konulamayan eksüdatif PE olan hastalarda yapılan torakoskopik biyopsinin etkinliği ve işlem sonrası uzun dönem takiplerin gözden geçirilmesidir.
 Gereç ve Yöntem: Ocak 2016 ile Aralık 2020 tarihleri arasında eksüdatif PE nedeniyle torakoskopik biyopsi uygulanan hastalar geriye dönük incelendi. Postoperatif en az 2 yıl takip edilebilen hastalar çalışmaya dahil edildi. Klinik ve fizik muayene, kan tahlilleri, plevral sıvının biyokimyasal, bakteriyolojik ve sitolojik incelemeleri, radyolojik ve histopatolojik veriler elde edildi.
 Bulgular: Hastaların 45'i (%61.6) erkek, 28'i (%38.3) kadındı. Yaş ortalaması 56,5±13,2 idi. Hiçbir hastada intraoperatif komplikasyon gelişmedi. Postoperatif dönemde 7 (%9) hastada komplikasyon gelişti. Üç (%4.1) hastada uzamış hava kaçağı, 2 (%2.7) hastada yara yeri enfeksiyonu ve 2 (%2.7) hastada pnömoni gelişti. Hastaların 21’inde (%28.7) malignite saptanırken 52 (%71.2) hastada benign patolojiler saptandı. Takip sırasında daha önce nonspesifik plörit tanısı alan ve tekrarlayan PE nedeniyle torakoskopik biyopsi yapılan 4 (%5.4) hastadan 2’sinde (%2.7) malign mezotelyoma saptandı.
 Tartışma: Sonuç olarak eksudatif PE’nin tanısında torakoskopik biyopsi tanısal değeri yüksek ve komplikasyonları nadir bir yöntemdir. Nonspesifik plevrit sonrası malignite gelişimi genellikle 1 yıl içerisinde olmakla birlikte nadiren 2 yıl içinde de gelişebilir. Bu nedenle nonspesifik plevrit sonrası takip süresinin 2 yıl olması gerektiği kanaatindeyiz.

Spontaneous Ventilation Thoracoscopic Lung Biopsy in Undetermined Interstitial Lung Disease: Systematic Review and Meta-Analysis.

Thoracoscopic surgical biopsy has shown excellent histological characterization of undetermined interstitial lung diseases, although the morbidity rates reported are not negligible. In delicate patients, interstitial lung disease and restrictive ventilatory impairment morbidity are thought to be due at least in part to tracheal intubation with single-lung mechanical ventilation; therefore, spontaneous ventilation thoracoscopic lung biopsy (SVTLB) has been proposed as a potentially less invasive surgical option. This systematic review summarizes the results of SVTLB, focusing on diagnostic yield and operative morbidity. A systematic search for original studies regarding SVTLB published between 2010 to 2023 was performed. In addition, articles comparing SVTLB to mechanical ventilation thoracoscopic lung biopsy (MVTLB) were selected for a meta-analysis. Overall, 13 studies (two before 2017 and eleven between 2018 and 2023) entailing 675 patients were included. Diagnostic yield ranged from 84.6% to 100%. There were 64 (9.5%) complications, most of which were minor. There was no 30-day operative mortality. When comparing SVTLB to MVTLB, the former group showed a significantly lower risk of complications (p < 0.001), whereas no differences were found in diagnostic accuracy. The results of this review suggest that SVTLB is being increasingly adopted worldwide and has proven to be a safe procedure with excellent diagnostic accuracy.

IR808@MnO nano-near infrared fluorescent dye’s diagnostic value for malignant pleural effusion

BackgroundMalignant pleural effusion is mostly a complication of advanced malignant tumors. However, the cancer markers such as carbohydrate antigen 125 (CA 125), carbohydrate antigen 15-3 (CA 15-3), carbohydrate antigen 19-9 (CA 19-9), and cytokeratin fragment 21-1 (CYFRA 21-1) have low sensitivity and organ specificity for detecting malignant pleural effusion.Research questionIs IR808@MnO nano-near infrared fluorescent dye worthy for the diagnosis in differentiating benign and malignant pleural effusions.Study design and methodsThis experiment was carried out to design and characterize the materials for in vitro validation of the new dye in malignant tumor cells in the A549 cell line and in patients with adenocarcinoma pleural effusion. The dye was verified to possess tumor- specific targeting capabilities. Subsequently, a prospective hospital-based observational study was conducted, enrolling 106 patients and excluding 28 patients with unknown diagnoses. All patients underwent histopathological analysis of thoracoscopic biopsies, exfoliative cytological analysis of pleural fluid, and analysis involving the new dye. Statistical analyses were performed using Microsoft Excel, GraphPad Prism, and the R language.ResultsThe size of IR808@MnO was 136.8 ± 2.9 nm, with peak emission at 808 nm, and it has near-infrared fluorescence properties. Notably, there was a significant difference in fluorescence values between benign and malignant cell lines (p < 0.0001). The malignant cell lines tested comprised CL1-5, A549, MDA-MB-468, U-87MG, MKN-7, and Hela, while benign cell lines were BEAS-2B, HUVEC, HSF, and VE. The most effective duration of action was identified as 30 min at a concentration of 5 μl. This optimal duration of action and concentration were consistent in patients with lung adenocarcinoma accompanied by pleural effusion and 5 μl. Of the 106 patients examined, 28 remained undiagnosed, 39 were diagnosed with malignant pleural effusions, and the remaining 39 with benign pleural effusions. Employing the new IR808@MnO staining method, the sensitivity stood at 74.4%, specificity at 79.5%, a positive predictive value of 69.2%, and a negative predictive value of 82.1%. The area under the ROC curve was recorded as 0.762 (95% CI: 0.652–0.872). The confusion matrix revealed a positive predictive value of 75.7%, a negative predictive value of 75.6%, a false positive rate of 22.5%, and a false negative rate of 26.3%.InterpretationThe IR808@MnO fluorescent probe represents an efficient, sensitive, and user-friendly diagnostic tool for detecting malignant pleural fluid, underscoring its significant potential for clinical adoption.

The clinical relevance of surgical specimens for RNA sequencing in lung cancer: a cohort study.

Molecular screening using next-generation sequencing (NGS) in the pathologic evaluation of lung cancer is considered the standard in clinical practice; hence, we evaluated the diagnostic yields of various sampling methods for NGS. NGS data from patients with lung cancer at the Pusan National University Hospital (Busan, South Korea), admitted October, 2020-April, 2023, was obtained. The sampling methods by which NGS data was obtained were divided into surgical and nonsurgical. Surgical methods included thoracoscopic surgery, surgical biopsy from the metastatic site, and lymph node excisional biopsy, whereas nonsurgical methods included bronchoscopy procedures and medical thoracoscopic biopsy. In total, we obtained 319 patients' NGS data:150 (47.0%) and 169 (53.0%) was obtained using surgical and nonsurgical methods, respectively. The overall diagnostic yield of NGS analysis was 97.5% for all samples. There were no significant differences in the success rates of deoxyribonucleic acid sequencing between surgical and nonsurgical sampling methods (98.0% vs. 96.4%, p = 0.313). On the other hand, the success rate of ribonucleic acid (RNA) sequencing was significantly lower in the surgical method group (78.0% vs. 92.3%; p < 0.001). Multivariate analysis showed that surgical sampling significantly correlated with RNA sequencing failure (Odd Ratio 4.128, 95% Confidence Interval 1.681-10.133, p = 0.002). Small samples obtained using nonsurgical procedures are suitable for NGS analysis in clinical practice. However, surgical sampling showed a relatively lower success rate for RNA sequencing than nonsurgical sampling. This information may help in the development of protocols to reduce RNA degradation during the surgical process.

Thoracoscopic biopsy in the diagnosis of lung and pleural diseases

Background: Thoracoscopy is a useful procedure for evaluation and diagnosis of pleural effusion and other thoracic disorders. Our study aimed to evaluate the scope and use of thoracoscopic biopsy for the evaluation of thoracic disorders and report on the outcomes of this technique. Methods: Patients undergoing thoracoscopic biopsy procedure from March 2022 to May 2023 were analyzed for indications, complication and outcomes. Results: 85 patients underwent thoracoscopic biopsy over a period of 15 months, of which 38 (44.7%) were males and 47 (55.3%) were females. The mean age was 60 years. Cough, dyspnea and chest pain were the most common presenting symptoms. Thoracosopy was most commonly done on the right side (67.1%). Pleura (57.6%) was the most common biopsy site, followed by lungs (22.4%), lymph node (12.9%) and mediastinum (3.7%). One case was converted to open procedure. Post operative complication rate was 3.5%. Adenocarcinoma (31.8%) was the most common histology, followed by squamous cell carcinoma (9.4%). 36.5% patients had benign disease and 11.8% patients had metastatic extra-thoracic malignancy. Conclusion: Thoracoscopy is a safe and simple procedure for diagnosis of pleural and other thoracic disorders with the advantage of tissue sampling from lesion under direct visualization. It is a useful tool in the armamentarium of thoracic surgeons.

Pleural Pustule-a Novel Thoracoscopic Appearance of Pleural Tuberculosis.

Thoracoscopic pleural biopsy is the gold standard for diagnosing tubercular pleural effusion (TPE). Various thoracoscopic appearances like sago grain nodules, caseous necrosis, and adhesions have been described in TPE. However, none of these have high specificity for diagnosing TPE. In this study we evaluate a novel finding on thoracoscopy, the "Pleural Pustule." This is a retrospective analysis of patients who underwent thoracoscopy for undiagnosed pleural effusion. Visual inspection of the pleura was performed to identify abnormalities. Biopsies were obtained from those areas and sent for histopathology, acid fast bacillus (AFB) smear, culture, and Xpert MTB/Rif assay. Pleural pustule was defined as a pus filled nodule on the pleural surface. Of the 259 patients included, 92 were diagnosed with TPE. Pleural pustule(s) were identified in 16 patients with TPE. Presence of pleural pustule had a sensitivity, specificity, positive predictive value, and negative predictive value of 17.4%, 100%, 100% and 68.7%, respectively, for diagnosing TPE. Histopathology of pleural pustule demonstrated necrotizing granulomas in all. In patients with pleural pustule, a microbiological diagnosis of tuberculosis was achieved in 93.7% patients (AFB smear, Xpert MTB/Rif assay, and MTB culture positive in 31.3%, 93.7%, and 43.7% cases, respectively). There is a strong association between pleural pustule and positive Xpert MTB/Rif assay (P=0.002) and microbiologic confirmation of diagnosis (P=0.017). The presence of pleural pustule on thoracoscopy has a high positive predictive value for TPE. In tuberculosis-endemic countries, this can be considered suggestive for TPE. When identified, a biopsy from the pleural pustule should be performed as it will likely yield a positive microbiologic diagnosis.

Case Series of Challenging Diagnosis for Recurrent Pleural and Pericardial Effusion

Three cases presented to our hospital with recurrent pleural and pericardial effusion. Detailed history of present and past illnesses were recorded. Thorough clinical examination done. All routine blood investigations were carried out. Pleural fluid, pericardial fluid peritoneal fluid were sent for analysis which revealed high ADA, exudative lymphocytic predominance, negative for malignancy and the patients were started on antitubercular therapy, but still patient didn’t show any response. thoracoscopic biopsy showed chronic inflammation. PET CT whole body and bone marrow biopsy revealed lymphoma.

Role of thoracoscopy in diagnosis of tubercular pleural effusion in low ADA setting- A prospective, observational study

BackgroundTubercular Pleural effusion (TBPE) is one of most common extrapulmonary tuberculosis. It can be difficult to diagnose due to low sensitivity of pleural fluid smear, culture and CBNAAT. Diagnosis of TBPE is then dependent on the level of pleural fluid Adenosine Deaminase (ADA). Thoracoscopic pleural biopsy gives definite diagnosis specially in Low Pleural fluid ADA setting. Aims and objectiveThis study was planned to find out the prevalence of tubercular etiology in patients of exudative pleural effusion with low ADA (ADA <40 IU/L). Material and methodsA Prospective, observational study was carried out in a tertiary teaching institute in north India. Total 142 patients of pleural effusion with low ADA were enrolled. All patients underwent rigid thoracoscopy for confirmation of their diagnosis. ResultsOut of 142 patients, male were 78 (55%) and female were 64 (45%). Mean age of patients were 57.4 years. Tuberculosis was diagnosed as a cause of effusion in 22 (15.5%) out of 142 patients. Majority of TBPE patients had pleural thickening as thoracoscopic finding. Mean ADA level in TBPE was 27.36 ± 11.6 as compared to 18.55 ± 9.02 in non tubercular pleural effusion patients and this difference was significant statistically (P- 0.002). ConclusionThe diagnosis of patients having exudative, low ADA pleural effusion can be very easily confirmed by thoracoscopy guided pleural biopsy which has a very high diagnostic yield.

Rapid on-site evaluation of touch imprints of medical thoracoscopy biopsy tissue for the management of pleural disease.

Medical thoracoscopy (MT) plays an important role in the diagnosis and treatment of pleural diseases, and rapid on-site evaluation (ROSE) has long been used for transbronchial needle aspiration or fine-needle aspiration to evaluate the adequacy of biopsy materials for the diagnosis of peripheral lung lesions. However, research on ROSE combined with MT for the management of pleural disease has been rarely reported. We aimed to evaluate the diagnostic performance of ROSE for pleura biopsies and visual diagnosis by thoracoscopists for gross thoracoscopic appearance. The secondary objective was to assess the intermodality agreement between ROSE and the final histopathologic diagnosis. A total of 579 patients with exudative pleural effusion (EPE) who underwent MT combined with ROSE from February 2017 to December 2020 at Taihe Hospital were included in the study. Thoracoscopists' visual diagnosis of gross thoracoscopic appearance, ROSE results, histopathologic findings, and the final diagnosis was recorded. Thoracoscopic pleural biopsies were performed in 565 patients (97.6%); 183 patients were confirmed to have malignant pleural effusion (MPE), and 382 patients were confirmed to have benign pleural effusion (BPE). The area under the curve of ROSE for the diagnosis of MPE was 0.96 (95% CI: 0.94-0.98, p < 0.001), with a sensitivity of 98.7%, a specificity of 97.2%, a diagnostic accuracy of 97.1%, a positive predictive value of 97.2%, and a negative predictive value of 97.2%. Diagnostic consistency between ROSE and histopathology was good (κ ± SE = 0.93 ± 0.02, p < 0.001). The area under the curve of the thoracoscopists' visual diagnosis of gross thoracoscopic appearance was 0.79 (95% CI: 0.75-0.83, p < 0.01), with a sensitivity of 76.7%, a specificity of 80.9%, a positive predictive value of 62.4%, and a negative predictive value of 89.3%. ROSE of touch imprints of MT biopsy tissue during MT showed high accuracy for distinguishing between benign and malignant lesions. In addition, ROSE was in good agreement with the histopathological diagnosis, which may help thoracoscopists perform pleurodesis (talc poudrage) directly during the procedure, especially in patients with malignant results.

Thoracoscopic Assisted PleuralPortTM Application in Seven Dogs Affected by Chronic Pleural Effusion.

Chronic non-septic pleural effusion is a condition that frequently may occur because of lung or pleural neoplasia, or chylothorax refractory to surgical treatment, in dogs. Effusion management can be performed with multiple pleurocenteses or the application of chest drains. New modified vascular devices have been used for patients with chronic diseases; they offer the advantage of allowing home management and do not require hospitalization. Eight PleuralPortTM devices were applied in seven dogs during thoracoscopic exploration and biopsy procedures; five were affected by mesothelioma; one by lung metastases from a mammary carcinoma; and one by chronic chylothorax. The median time of surgical procedure was 51 min; one developed pneumothorax post-operatively that resolved within 12 h after repeated drainage; one device was obstructed after 45 days and was successfully managed by flushing. All patients were discharged after 24 h. The median duration of port insertion in cancer patients was 5 months and those dogs were euthanized because of tumor progression; in the dog with chylothorax, the device was removed after 1 year when the effusion had resolved.