Diagnostic accuracy of semirigid thoracoscopy in exudative pleural effusions and relationship of thoracoscopic findings with probability of malignant diagnosis
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.
Jacobaeus HC. [Über Laparo- und Thorakoskopie].[Article in German]. Beitr Klin Tuberk 1912;25:185–354. DOI: https://doi.org/10.1007/BF01875367
Boutin C, Cargnino P, Viallat JR. Thoracoscopy in the early diagnosis of malignant pleural effusions. Endoscopy 1980;12:155-60. DOI: https://doi.org/10.1055/s-2007-1021734
Ryan CJ, Rodgers RF, Unni KK, Hepper NG. The outcome of patients with pleural effusion of indeterminate cause at thoracotomy. Proc. Mayo Clin 1981;56:145-9.
Menzies R, Charbonneau M. Thoracoscopy for the diagnosis of pleural disease. Ann Intern Med 1991;114:271–6. DOI: https://doi.org/10.7326/0003-4819-114-4-271
Loddenkemper R. Thoracoscopy - state of the art. Eur Respir J 1998;11:213–21. DOI: https://doi.org/10.1183/09031936.98.11010213
Jiménez D, Pérez-Rodriguez E, Diaz G, et al. Determining the optimal number of specimens to obtain with needle biopsy of the pleura. Respir Med 2002;96:14–7. DOI: https://doi.org/10.1053/rmed.2001.1200
Boutin C, Viallat JR, Cargnino P. [Current indications for thoracoscopy].[Article in French]. Rev Fr Mal Respir 1981;9:309-18.
Mohan A, Naik S, Naseer R, et al. Performance characteristics of semirigid thoracoscopy in pleural effusions of undetermined etiology. J Bronchol Interv Pulmonol 2010;17:289-94. DOI: https://doi.org/10.1097/LBR.0b013e3181f9ebca
Poe RH, Israel RH, Utell MJ, et al. Sensitivity, specificity, and predictive values of closed pleural biopsy. Arch Intern Med 1984;144:325-8. DOI: https://doi.org/10.1001/archinte.144.2.325
Hooper C, Lee YCG, Maskell N, BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65:ii4-17. DOI: https://doi.org/10.1136/thx.2010.136978
Munavvar M, Khan MaI, Edwards J, et al. The autoclavable semirigid thoracoscope: the way forward in pleural disease? Eur Respir J 2007;29:571-4. DOI: https://doi.org/10.1183/09031936.00101706
Lee P, Hsu A, Lo C, Colt HG. Prospective evaluation of flex-rigid pleuroscopy for indeterminate pleural effusion: Accuracy, safety and outcome. Respirology 2007;12:881-6. DOI: https://doi.org/10.1111/j.1440-1843.2007.01144.x
Bakr R, Elmahallawy I, Mansour O, et al. Role of medical thoracoscopy in diagnosis of recurrent undiagnosed pleural effusion. Eur Respir J 2012;40:P1258.
Helala LA, El-Assal GM, Farghally AA, El Rady MMA. Diagnostic yield of medical thoracoscopy in cases of undiagnosed pleural effusion in Kobri El-Kobba Military Hospital. Egypt J Chest Dis Tuberc 2014;63:629-34. DOI: https://doi.org/10.1016/j.ejcdt.2014.04.002
Kiani A, Abedini A, Karimi M, et al. Diagnostic yield of medical thoracoscopy in undiagnosed pleural effusion. Tanaffos 2015;14:227-31.
Valsecchi A, Arondi S, Marchetti G. Medical thoracoscopy: Analysis on diagnostic yield through 30 years of experience. Ann Thorac Med 2016;11:177. DOI: https://doi.org/10.4103/1817-1737.185755
Thangakunam B, Christopher DJ, James P, Gupta R. Semi-rigid thoracoscopy: initial experience from a tertiary care hospital. Indian J Chest Dis Allied Sci 2010;52:25-7.
Nattusamy L, Madan K, Mohan A, et al. Utility of semi-rigid thoracoscopy in undiagnosed exudative pleural effusion. Lung India 2015; 32:119–26. DOI: https://doi.org/10.4103/0970-2113.152618
Shah NN, Mehfooz N, Farooq SS, et al. Medical thoracoscopy- an experience. Int J Res Med Sci 2017;5:2176–81. DOI: https://doi.org/10.18203/2320-6012.ijrms20171865
Mohan A, Chandra S, Agarwal D, et al. Utility of semirigid thoracoscopy in the diagnosis of pleural effusions: a systematic review. J Bronchol Interv Pulmonol 2010;17:195–201. DOI: https://doi.org/10.1097/LBR.0b013e3181e6a2e7
Dhooria S, Singh N, Aggarwal AN, et al. A randomized trial comparing the diagnostic yield of rigid and semirigid thoracoscopy in undiagnosed pleural effusions. Respir Care 2014;59:756–64. DOI: https://doi.org/10.4187/respcare.02738
Asmita M, V R, Vishwam D, et al. Value of semirigid thoracoscopy in pleural effusion. Pulmon 2010;12:43–5.
Hansen M, Faurschou P, Clementsen P. Medical thoracoscopy, results and complications in 146 patients: a retrospective study. Respir Med 1998;92:228–32. DOI: https://doi.org/10.1016/S0954-6111(98)90100-7
Blanc F-X, Atassi K, Bignon J, Housset B. Diagnostic value of medical thoracoscopy in pleural disease: a 6-year retrospective study. Chest 2002;121:1677–83. DOI: https://doi.org/10.1378/chest.121.5.1677
Prabhu VG, Narasimhan R. The role of pleuroscopy in undiagnosed exudative pleural effusion. Lung India 2012;29:128–30. DOI: https://doi.org/10.4103/0970-2113.95304
Chen R-L, Zhang Y-Q, Wang J, et al. Diagnostic value of medical thoracoscopy for undiagnosed pleural effusions. Exp Ther Med 2018;16:4590-4. DOI: https://doi.org/10.3892/etm.2018.6742
Venekamp LN, Velkeniers B, Noppen M. Does ‘idiopathic pleuritis’ exist? Natural history of non-specific pleuritis diagnosed after thoracoscopy. Respiration 2005;72:74-8. DOI: https://doi.org/10.1159/000083404
Agarwa R, Aggarwal AN, Gupta D. Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions: a meta-analysis. Chest 2013;144:1857-67. DOI: https://doi.org/10.1378/chest.13-1187
- Abstract views: 51
- PDF: 17
Copyright (c) 2021 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.