Comparison between closed pleural biopsy and medical thoracoscopy for the diagnosis of undiagnosed exudative pleural effusions: a systematic review and meta-analysis

Abstract

Background: Exudative pleural effusion (EPE) is a common diagnostic challenge. The utility of medical thoracoscopy (MT) and closed pleural biopsy (CPB) to aid in the diagnosis of EPE has been reported in many published studies. Herein, we perform a systematic review and meta-analysis to compare the diagnostic yield and safety of CPB and MT in EPE.Methods: Four databases were searched for studies reporting the diagnostic yield of CPB and MT for EPE. The quality of the included studies was evaluated according to the quality assessment of diagnostic accuracy studies (QUADAS) tool. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and complication risks were compared between the two groups.Results: Ten studies dealing with CPB and twenty-three studies dealing with MT for the diagnosis of EPE were included in this meta-analysis.

Diagnostic value and safety of thoracoscopic pleural biopsies in pleural exudative effusions of unknown origin, including follow-up

“…These data represent our experience of medical thoracoscopy in a period of almost 10 years, the first Belgian data to be published to my knowledge. The amount of patients is comparable to other studies 6–8…”

“…General sensitivity in our data was between 80.9% and 92.4%. This is comparable to the sensitivity of 93% in the recent meta-analysis of Wei et al , however, for local anaesthesia thoracoscopy 7. Sensitivities for video assisted thoracoscopy under general anaesthesia are, however, in the same range or a little higher (ranging from 82.3% to 95.2%) 8 10–12…”

“…The amount of patients is comparable to other studies. [6][7][8] Out of 49 patients with nonspecific pleuritis 15 had less than 6 months of follow-up, and thus, we calculated a maximal and minimal sensitivity, as was done before in another study. 9 Due to the little number of some diagnoses these parameters sometimes have a wide range, which makes it impractical for daily use.…”

“…This is comparable to the sensitivity of 93% in the recent meta-analysis of Wei et al, however, for local anaesthesia thoracoscopy. 7 Sensitivities for video assisted thoracoscopy under general anaesthesia are, however, in the same range or a little higher (ranging from 82.3% to 95.2%). 8 10-12 Negative predictive value range is 57.6%-83.1% for any diagnosis, which is comparable to 76% of McDonald et al 8 but probably a bit lower than 85%-90% in Menzies et al 9 (95% CI 84% to 96% and 78% to 92%, depending on possible diagnoses in patients lost to follow-up).…”

Sensitivity and complications of thoracentesis and thoracoscopy: a meta-analysis

“…report sensitivity by cancer type. Instead, diagnostic accuracy of thoracoscopy for MPE and mesothelioma was reported [12]. Thus, we decided to perform meta-analyses on thoracentesis and thoracoscopy to provide updated estimates of their sensitivity for MPE stratified by cancer type when possible.…”