Diagnostic accuracy of semirigid thoracoscopy in exudative pleural effusions and relationship of thoracoscopic findings with probability of malignant diagnosis

Abstract

Semirigid thoracoscopy is increasingly becoming the procedure of choice for evaluation of undiagnosed exudative pleural effusions. Few studies have reported relationship of thoracoscopic appearances of pleural abnormalities and etiological diagnoses. We aimed our study to assess the diagnostic utility and safety of semirigid thoracoscopy for evaluation of patients with undiagnosed exudative pleural effusion. Further, we also pursued to find any relation of various thoracoscopic findings with the final diagnosis. We prospectively enrolled hospitalized patients with undiagnosed exudative pleural effusion who underwent semirigid thoracoscopy. Demographic, clinical and laboratory data along with data on thoracoscopic appearance of various pleural abnormalities and histopathological diagnosis of pleural biopsy specimens were collected and analysed. Semirigid thoracoscopy was diagnostic in 46 (N=55) patients (83.64%). Malignancy was diagnosed in 31 patients (56.36%), of which adenocarcinoma was the most common histopathological diagnosis (45.16%). Sensitivity, specificity, PPV, NPV LR+ and LR- of thoracoscopy were 93.87%, 100%, 100%, 66.67%, 40.30 and 0.06, respectively. Pleural nodules, masses and hemorrhagic pleural fluid significantly increased the diagnosis yield of malignancy [OR= 37.16 (95%CI = 3.61-382.65), =0.002]. The procedure related complications were mild and transient. Post- procedural pain (20%) was most commonly reported followed by dry cough (18.18%), sub-cutaneous emphysema (7.27%) and anaesthesia related complication (1.82%). Semirigid thoracoscopy is simple, safe and effective procedure in diagnosing exudative pleural effusion of unknown etiology with high diagnostic accuracy and minor procedure related complications. The likelihood of diagnosing malignancy is high if combination of pleural nodules, masses and hemorrhagic pleural fluid is present.

Comparison of Diagnostic Yield and Complications in Ultrasound-Guided Closed Pleural Biopsy Versus Thoracoscopic Pleural Biopsy in Undiagnosed Exudative Pleural Effusion

“…In our study, the diagnostic yield of medical thoracoscopy was 94.7%, indicating a high yield in undiagnosed exudative pleural effusion, which is similar to the diagnostic yield of 90 to 97% reported in various studies [10][11][12][13]. A diagnostic yield of 66 to 97% has been reported in Indian studies [14][15][16][17][18]. A higher yield can be explained by the fact that thoracoscopy allows for better visualization of the pleural cavity, including the costal, diaphragmatic, and visceral pleural surfaces, as well as the underlying lung, providing more information on the extent of the disease and allows for real-time and adequate pleural tissue sampling from the diseased pleura.…”

“…Diagnostic yield was 90% (18/20) and 94.7% (18/19) in the ultrasound and thoracoscopic groups, respectively, which was statistically non-significant (p=0.963). The median duration of hospital stay was 9.5 (5.3-27) days and 15 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) days in ultrasound and thoracoscopic groups respectively. The thoracoscopic group had a more prolonged stay compared to the ultrasound group, but it was statistically non-significant (p=0.09).…”

Prospective Evaluation of Safety and Diagnostic Efficacy of Medical Thoracoscopy in Undiagnosed Exudative Pleural Effusion: Experience From a Tuberculosis High-Burden Country

“…In our study, 16.1% of patients had minor bleeding following MT but required specific interventions. Post-procedure bleeding in ICD was also reported in other studies [ 19 , 25 ]. One patient (0.9%) developed pneumomediastinum, which resolved spontaneously after five days of oxygen therapy.…”

“…Kuwal et al found that MT had a sensitivity of 93.88% and a specificity of 100% [ 25 ]. In a meta-analysis, Agarwal et al reported the sensitivity and specificity of MT for the diagnosis of pleural effusion as 91% and 100%, respectively [ 26 ].…”

“…Similarly, Wang et al also reported transient chest pain in 44% of patients following the procedure [ 21 ]. Kuwal et al reported chest pain among 20% of the patients who underwent MT [ 25 ]. However, the proportion of patients who experienced chest pain was higher in our study.…”