Utility of Semirigid Thoracoscopy in the Diagnosis of Pleural Effusions

Chandra, Subhash; Agarwal, Deepmala; Naik, Samir; Munavvar, Mohammed

doi:10.1097/lbr.0b013e3181e6a2e7

Cited by 30 publications

(22 citation statements)

References 16 publications

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“…The procedure is generally considered to be safe and well-tolerated, especially with semi-rigid instruments with no reported mortality to date (Lee and Colt [22]; Mohan et al [23]). Mortality rates with rigid instruments were reported to be between 0.09% and 0.24%, and with reported complication rates from 2% to 6 % (Rodriguez-Panadero [24]; Casal et al [25]; Medford et al [26]).…”

Section: Discussionmentioning

confidence: 98%

Diagnostic yield of medical thoracoscopy in cases of undiagnosed pleural effusion in Kobri El-Kobba Military Hospital

Helala

Elassal

Farghally³

et al. 2014

Egyptian Journal of Chest Diseases and Tuberculosis

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Background: Recurrent and persistent pleural exudates are common in clinical practice, and in a large number of patients, thoracocentesis and blind pleural biopsy procedures do not provide a definitive diagnosis. In the Western world, the majority of these exudates are malignant. Thoracoscopy today remains the gold standard technique in providing diagnosis and management in these cases.Objectives: Diagnostic yield of medical thoracoscopy was evaluated in cases of undiagnosed pleural effusion.Patients and methods: Semi flexible medical thoracoscopy was done for 40 patients in the period between

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Section: Discussionmentioning

confidence: 98%

Diagnostic yield of medical thoracoscopy in cases of undiagnosed pleural effusion in Kobri El-Kobba Military Hospital

Helala

Elassal

Farghally³

et al. 2014

Egyptian Journal of Chest Diseases and Tuberculosis

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“…10 Two recent systematic reviews have concluded that the semirigid pleuroscope is a safe, easy-to-handle, and accurate tool in the diagnosis of pleural effusions of undetermined origin. 11,12 Another retrospective study 13 found comparable histologic yields of the rigid and the semirigid thoracoscopes. There is only one published randomized trial 14 comparing the yield of the 2 instruments wherein the authors found comparable diagnostic accuracy of the 2 instruments despite the smaller biopsy size obtained with the semirigid device.…”

Section: Introductionmentioning

confidence: 99%

A Randomized Trial Comparing the Diagnostic Yield of Rigid and Semirigid Thoracoscopy in Undiagnosed Pleural Effusions

et al. 2013

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BACKGROUND: Thoracoscopic pleural biopsy increases the diagnostic yield of pleural effusions undiagnosed after thoracentesis and is superior to closed pleural biopsy. Medical thoracoscopy can be performed using the rigid thoracoscope or the semirigid thoracoscope (pleuroscope). In this randomized trial, we compare the efficacy and safety of the 2 thoracoscopes. METHODS: Subjects with undiagnosed exudative pleural effusions were randomly assigned to undergo pleural biopsy with either the rigid or the semirigid thoracoscope. The primary outcome was the diagnostic yield of the procedure, while the secondary outcomes were requirement of sedative/analgesic agents, scar size, biopsy sample size, and the operator's view of the procedure. RESULTS: Of the 145 screened subjects with exudative pleural effusions, 90 were randomized to undergo thoracoscopy with the 2 thoracoscopes (n ‫؍‬ 45 each). The diagnostic yield of rigid thoracoscopy was superior to semirigid thoracoscopy (97.8% vs 73.3%, P ‫؍‬ .002) on an intention-to-treat analysis but was similar (100% vs 94.3%, P ‫؍‬ .18) in those with successful biopsy. The requirement of sedative/analgesic agents was higher in the rigid thoracoscopy arm. The scar size was slightly larger (mean ؎ SD, 23.1 ؎ 4 vs 18.7 ؎ 3.2 mm, P ‫؍‬ .0001), whereas the biopsy sample size was distinctly larger in the rigid arm (mean ؎ SD, 13.9 ؎ 4.4 vs 4.4 ؎ 1.4 mm, P ‫؍‬ .001). The operator-rated visual analog scale score for the ease of taking a biopsy sample was significantly higher with the rigid instrument (mean ؎ SD, visual analog scale 86 ؎ 12 vs 79 ؎ 12 mm, P ‫؍‬ .01), while the quality of image was superior in the semirigid arm (mean ؎ SD, visual analog scale 88 ؎ 7 vs 92 ؎ 5 mm, P ‫؍‬ .002). The number of complications were similar in the 2 groups. CONCLUSIONS: Rigid thoracoscopy was found to be superior to semirigid thoracoscopy overall, but the diagnostic yield was similar if pleural biopsy could be successfully performed. Due to the small sample size, a larger study is required to define the usefulness and choice between the 2 procedures. (ClinicalTrials.gov registration NCT01726556)

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“…In an extensive review article by the same authors regarding semirigid thoracoscopy, positive likelihood ratio (LR+) was 5.47 and negative likelihood ratio (LR−) was 0.08 (49). Both values indicate that this procedure is highly useful for determining the presence or absence of disease.…”

Section: Semirigid Thoracoscopymentioning

confidence: 94%

“…In this form, it is an endoscope warranting the definition of "pleuroscope". The first model of semirigid thoracoscope was brought into use in 1997, and the model, which is used at present, was developed in 2002 (8).…”

Section: Semirigid Thoracoscopymentioning

confidence: 99%

Medical thoracoscopy at 105. Anniversary

Metintaş¹

2015

Eurasian J Pulmonol

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Medical thoracoscopy (MT) for cases of exudative pleural effusion without a diagnosis by either clinical, radiological, laboratory or cytological investigation is performed as an established diagnostic method for the diagnosis of pleural diseases which has been performed routinely in many clinics. MT was done mainly with a rigid thoracoscope under mild sedation and local anesthesia in an endoscopy room with basic monitoring. It allows for the direct inspection of the pleural space and biopsies taken under direct vision. The diagnostic yield is in the order of 90-95% for malignant disease and can be as high as 100% for pleural tuberculosis. Additionally, MT can be performed for therapeutic as well as diagnostic purposes. Although MT remains an invasive procedure, complications are infrequently seen. Due to both the advantages of MT and the gradually increasing incidence of mesothelioma and malignant pleural disease, the use of MT for pleural effusions will be increasing in pulmonary clinics in coming years. Additionally MT will have some new developments; such as semirigid thoracoscopy, florescent or auto-florescent thoracoscopy, narrow-band imaging, thoracoscopy in patients without pleural effusion.

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Utility of Semirigid Thoracoscopy in the Diagnosis of Pleural Effusions

Abstract: Semirigid thoracoscopy seems to be a safe, simple, and accurate tool for undiagnosed pleural effusions. It is well tolerated and is devoid of major complications. Further studies with sound methodology will further help to define the future role of this procedure.

Cited by 30 publications

References 16 publications

Diagnostic yield of medical thoracoscopy in cases of undiagnosed pleural effusion in Kobri El-Kobba Military Hospital

Diagnostic yield of medical thoracoscopy in cases of undiagnosed pleural effusion in Kobri El-Kobba Military Hospital

A Randomized Trial Comparing the Diagnostic Yield of Rigid and Semirigid Thoracoscopy in Undiagnosed Pleural Effusions

Medical thoracoscopy at 105. Anniversary

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