Diagnostic Accuracy and Safety of Medical Thoracoscopy

Abstract

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.

Medical Thoracoscopy in Pleural Disease: Experience from a One-Center Study

“…Previous studies have reported a diagnostic yield for MT that ranges from 85% to 100%. In our study, the diagnostic yield was 96.2%, which was comparable to previous studies 3 4 15 . Interestingly, one case was diagnosed as IgG4-related pleural disease in our study, and MT findings were very similar to those from a previous study 16 .…”

“…Yang et al15 reported that it was a safe method for diagnosing patients with unknown pleural effusions and had a relatively high diagnostic accuracy. However, they did not include therapeutic MT.…”

“…Although MT has become more readily available in Europe and North America over the past two decades 2 , it is still an unfamiliar procedure in Korea, and only a few reports have been published there 15 21 . Yang et al 15 reported that it was a safe method for diagnosing patients with unknown pleural effusions and had a relatively high diagnostic accuracy. However, they did not include therapeutic MT.…”