Yield Of Medical Thoracoscopy Research Articles

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.

Yield of medical thoracoscopy in undiagnosed exudative pleural effusion: a 3-year retrospective multicenter study

Background The diagnosis of the etiology of exudative pleural effusion is a great challenge in clinical practice. Aims To evaluate the diagnostic value of medical thoracoscope in unexplained exudative effusions and the frequency of various diagnoses in a multicenter study in Egypt. Patients and methods A retrospective analysis was done of all thoracoscopies done at our centers for diagnosis of the cause of the exudative pleural effusion. Results Among 542 thoracoscopies performed at our centers, definite diagnosis was reached in 476 (87.8%) cases. Malignancy was the most common diagnosis (60.7%) followed by tuberculosis (24.5%). Conclusion Thoracoscopy was a safe and efficient tool for diagnosis. Malignancy and tuberculosis were the most common etiologies.

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.

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.

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.

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.