Investigation of pleural effusion: comparison betweenfibreoptic thoracoscopy, needle biopsy and cytology

Edmondstone, W M

doi:10.1016/s0954-6111(08)80089-3

Cited by 36 publications

(21 citation statements)

References 6 publications

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“…Nearly identical findings were reported by many investigators [7,17]. Also, the diagnostic yield of thoracoscopy (94%) was significantly higher than that of pleural fluid cytology (62%) (p < 0.01), pleural needle biopsy (50%) (p < 0.001), and combined pleural fluid cytology and pleural needle biopsy (69%) (p < 0.05).…”

Section: Discussionsupporting

confidence: 85%

Pleural Lavage: A Novel Diagnostic Approach For Diagnosing Exudative Pleural Effusion

Mohamed

Mobasher

Yousef

et al. 2000

Lung

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Patients with pleural effusions frequently present a diagnostic and therapeutic challenge. The diagnosis is based on the interpretation of the results of thoracentesis or pleural biopsy. When a malignant tumor metastasizes to the pleura, tumor cells can be seeded over the mesothelial surface or in the subserous layer. In the former situation, tumor cells are abundant in pleural fluid, but in the latter, few malignant cells are exfoliated into the pleural cavity, and microscopic deposits may not be visualized at thoracoscopy. Pleural lavage cytologic study at the time of thoracoscopy has not been studied. The purpose of this study was to assess the value of thoracoscopic pleural lavage as an adjuvant in the diagnostic workup of patients with exudative pleural effusions. Fifty patients with exudative pleural effusions were investigated by pleural fluid cytologic findings, Abram's pleural biopsy, thoracoscopy, and pleural lavage cytologic findings. After aspiration of all pleural fluid, 300 mL saline was instilled into the pleural cavity and then recovered for cytologic analysis. The final diagnoses were 32 malignant (64%), 15 tuberculous (30%), and 3 idiopathic (6%) effusions. In the malignant group, thoracoscopic biopsy had the highest yield (94%) followed by lavage cytologic analysis (84%), fluid cytologic analysis (62%), and biopsy with Abram's needle (50%). The sensitivity of combined thoracoscopy and lavage cytologic analysis was 96%. In the patients with tuberculous pleuritis, the yield from the pathologic examination of the biopsy specimen was 93% with thoracoscopy and 60% with the Abrams needle. The diagnostic yield with cytologic analysis on pleural lavage fluid is significantly higher than that on pleural fluid. This is probably because the cells in the lavage fluid are fresher and better preserved than those in the regular pleural fluid, which may have undergone degenerative changes, yielding false-negative results. Pleural lavage cytologic analysis should be performed in patients with suspected malignant pleural effusion who are subjected to diagnostic thoracoscopy, because it may provide additional information to thoracoscopic biopsy.

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Section: Discussionsupporting

confidence: 85%

Pleural Lavage: A Novel Diagnostic Approach For Diagnosing Exudative Pleural Effusion

Mohamed

Mobasher

Yousef

et al. 2000

Lung

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“…Received 27 March 1997; accepted for publication 11 November 1997. evaluation of pleural effusion, video assisted thoracoscopy having largely superseded traditional single port rigid thoracoscopy for interventional pr0cedures. j We report here our experience with the rigid thoracoscope in the diagnosis of unexplained pleural effusion.…”

Section: Introductionmentioning

confidence: 99%

Medical thoracoscopy in the diagnosis of unexplained pleural effusion

Wilsher

Veale

1998

Respirology

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Approximately 20% of pleural effusions remain without an established aetiology after evaluation. Thoracoscopy has a very high sensitivity for the diagnosis of both benign and malignant diseases and greatly increases the diagnostic yield for pleural effusion. We sought to evaluate the diagnostic yield and safety of medical thoracoscopy at this institution. The records of all patients undergoing medical thoracoscopy for the evaluation of undiagnosed pleural effusion between 1990 and 1996 were reviewed. The procedure was performed under local anaesthesia with sedation using a Stortz rigid thoracoscope. Fifty-eight patients had thoracoscopy, most having had two (range: 1-6) non-diagnostic pleural aspirations and biopsies of the pleura. Nineteen patients were found to have mesothelioma and nine metastatic malignancy. Three patients were considered likely to have tuberculous pleural disease, six had asbestos related benign pleural fibrosis and three post-cardiotomy syndrome. There was one chylous effusion of uncertain aetiology, one posttraumatic and two other benign effusions, both of which resolved without clear aetiology. On seven occasions the pleural space could not be adequately accessed, but none of these patients had prior computerized tomography (CT) or ultrasound of the pleural space. There were five false negative diagnoses of malignancy, but no false positives. The diagnostic sensitivity for pleural malignancy was 85% and specificity 100%. There were no major complications, but four patients had late tumour seeding at the thoracoscopy site. Medical thoracoscopy is a safe procedure with a high diagnostic yield. Pre-operative evaluation of the pleural collection using ultrasound or CT increases the likelihood of successful access to the pleural space and may increase diagnostic yield.

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“…Cytologic analysis of thoracentesis fluid is positive in 45 to 80% of malignant pleural effusions; however, it is positive in as few as 20% of patients with mesothelioma. 2,[12][13][14][15][16][17] Repeated thoracentesis for cytologic analysis provides limited increases in yield (17 to 22% additional yield for malignancy). 14,18 Thus, closed pleural biopsy in addition is advocated by some authors to further increase the diagnostic yield.…”

Section: Diagnostic Thoracoscopymentioning

confidence: 99%

“…Pleurodesis can also be achieved by pleurectomy using standard dissection techniques or hydrodissection. 12 Because survival of patients with advanced pleural carcinomatosis is often short, the risks and benefits of thoracoscopic pleurodesis must be carefully weighed against those of repeated thoracentesis, tube thoracostomy, or bedside pleurodesis through an indwelling chest tube. The talc stimulates an adhesive obliterative pleuritis.…”

Section: Malignant Pleural Effusionsmentioning

confidence: 99%

The Role of Thoracoscopy in Diagnosis and Treatment of Pleural Disease

Soni¹,

Bansal²,

Goel³

2012

WJOLS

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Intrathoracic disease involving lungs and pleura encountered frequently and remains a challenging clinical problem.The definitive diagnosis of lung or pleural disease some times remain unclear despite thoracocentesis, closed pleural biopsy, transthoracic needle aspiration or bronchoscopy. Recent advances in endoscopic technique, video equipment and development of better instrumentation have contributed to the resurgence of thoracoscopy as a diagnostic and thoracoscopic modality.

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Investigation of pleural effusion: comparison betweenfibreoptic thoracoscopy, needle biopsy and cytology

Cited by 36 publications

References 6 publications

Pleural Lavage: A Novel Diagnostic Approach For Diagnosing Exudative Pleural Effusion

Pleural Lavage: A Novel Diagnostic Approach For Diagnosing Exudative Pleural Effusion

Medical thoracoscopy in the diagnosis of unexplained pleural effusion

The Role of Thoracoscopy in Diagnosis and Treatment of Pleural Disease

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