Diagnostic Utility of Sago-Like Nodules on Gross Thoracoscopic Appearance in Tuberculous Pleural Effusion and Their Correlation with Final Histo-Microbiologic Findings

Thomas, Merlin; Ibrahim, Wanis H; Raza, Tasleem; Mushtaq, Kamran; Arshad, Adeel; Ahmed, Mushtaq; Taha, Salma; Omer, Shireen; Sarafandi, Saber Al; Rabadi, Omer; Abdulsattar, Hisham

doi:10.4236/jtr.2018.64024

Cited by 9 publications

(14 citation statements)

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“…The sensitivity, specificity and positive predictive value of sago nodules was 58.9 %, 92.6 % and 94.29 % respectively. This is in concordance with the results of Thomas et al, where they reported sensitivity, specificity and positive predictive value of sago nodules for tuberculous pleural effusion to be 58 %, 89 % and 97 % respectively 22 . This also agrees with the results from a Chinese study which reported a sensitivity, specificity and positive predictive value of miliary nodules on pleural as 64.47 %, 86.67 % and 96.08 % respectively 23 .…”

Section: Discussionsupporting

confidence: 92%

Visual Diagnosis of Pleural Tuberculosis and its Association with Tissue Biopsy, Culture and Xpert Assay

et al. 2021

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Introduction The diagnosis of pleural tuberculosis remains a clinical challenge due to the paucibacillary nature of disease. Medical thoracoscopy remains the gold standard in diagnosing tuberculous pleuritis. Objective To establish the diagnostic yield of sago-seed thoracoscopic appearance of pleura in tuberculosis and its correlation with histopathology, tissue AFB culture and tissue Xpert MTB/Rif assay. Methods All consecutive patients with lymphocytic exudative pleural effusion, who fulfilled inclusion criteria of the study underwent medical thoracoscopy under local anesthesia and pleural tissue was sent for histopathology, AFB culture and Xpert MTB/Rif assay. Chronic granulomatous inflammation on histopathology and response to anti-tuberculous treatment was taken as reference standard for diagnosis of tuberculous pleurisy. Results A total of 249 patients were included in the study, out of which 168 had effusion secondary to tuberculosis. Sago-like nodules visualized on thoracoscopy had a sensitivity of 58.9 %, specificity of 92.6 % and diagnostic accuracy of 69.88 % for pleural tuberculosis. There is a strong association between the presence of sago-like nodules and detection of mycobacterium tuberculosis on Xpert MTB/Rif assay and AFB culture of pleura (p-value 0.007). Conclusion Sago seed nodules on pleura have a high positive predictive value for tuberculous pleurisy. In high endemic countries patients with this finding on thoracoscopy can be commenced on anti-tuberculous treatment before histopathology or culture results are available.

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Section: Discussionsupporting

confidence: 92%

Visual Diagnosis of Pleural Tuberculosis and its Association with Tissue Biopsy, Culture and Xpert Assay

et al. 2021

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“…“Sago”‐like nodules are the most common visual appearance, and its presence has high specificity and positive predictive value to make a diagnosis of tubercular pleural effusion 1 . In the index case, thoracoscopic biopsy revealed multiple aggregates of epitheloid cell granulomas with multinucleated giant cells, caseous necrosis (Figure 2A), and multiple acid fast bacilli on Zeihl Neelsen stain (Figure 2B) confirming the diagnosis of tuberculosis.…”

Section: Discussionmentioning

confidence: 94%

Sago‐like appearance of pleura in Tuberculosis

Dhungana

Shrestha

2020

Clinical Case Reports

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“…This contradicts previous literature which suggests that the presence of nodules is pathognomonic of malignant disease [7]. Nodules have been described in benign diseases such as tuberculosis (sago pattern) [18] and rarely rheumatoid nodules have been described [19]. There are benign lesions that mimic a localized nodule such as thoracic splenosis, pleural endometriosis, thoracolithiasis, foreign bodies, pleural plaques, and pleural pseudotumor [20].…”

Section: Discussionmentioning

confidence: 97%

Objective Thoracoscopic Criteria in Differentiation between Benign and Malignant Pleural Effusions

et al. 2021

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Background: Thoracoscopy is the “gold standard” diagnostic modality for investigation of suspected pleural malignancy. It is postulated that meticulous assessment of the pleural cavity may be adequate to indicate malignancy through the macroscopic findings of nodules, pleural thickening, and lymphangitis. We attempted to critically assess this practice, by precisely defining objective macroscopic criteria which might differentiate benign from malignant pleural diseases according to intrapleural pattern and anatomical location, and thereby to explore the predilection of abnormalities to specific sites on pleural surfaces. Methods: A structured review of recorded video footage from medical thoracoscopy procedures in 96 patients was conducted by 2 independent assessors. Abnormalities were scored on agreed, objective criteria for the presence of nodules, lymphangitis and inflammation on each of the costoparietal, visceral and diaphragmatic surfaces. The costoparietal pleura was divided into 6 levels (apical, middle, and inferior surfaces of the lateral and posterior parietal pleura). The anterior surface of the costoparietal pleura was excluded from analysis after interim review as this surface was rarely seen. Results: In the benign group, inflammation was the predominant finding in 65% (n = 33; costoparietal), 44% (n = 21; visceral), and 42% (n = 15; diaphragmatic). Nodules were detected in 24% (n = 12; costoparietal), 8% (n = 4; visceral), and 8% (n = 3; diaphragmatic). The most affected surfaces with inflammation were the middle lateral (60%) and the inferior lateral (57.8%) parts of the costoparietal pleura. In the malignant group, nodules were the predominant finding according to surface in 73% (n = 33; costoparietal), 32% (n = 13; visceral) and 48% (n = 17; diaphragmatic). Inflammation was detected in 44% (n = 20; costoparietal), 25% (n = 10; visceral), and 29% (n = 10; diaphragmatic). The most affected surfaces with nodules were the middle lateral (67.4%) and inferior lateral (66.7%) costoparietal pleural surfaces. Conclusion: This is the first detailed, anatomical description of abnormalities in the pleural space during thoracoscopy. While nodules were the predominant pattern in malignant pleural effusion, they were detected in 24% of benign diagnoses. Detection of nodules in >1 area of the costoparietal pleura was in favor of a malignant diagnosis. Inflammation was the predominant pattern in benign pleural effusion. Our results suggest that macroscopic nodules in malignant diagnoses have a predilection for the middle and inferior surfaces of the lateral costoparietal pleura.

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Diagnostic Utility of Sago-Like Nodules on Gross Thoracoscopic Appearance in Tuberculous Pleural Effusion and Their Correlation with Final Histo-Microbiologic Findings

Cited by 9 publications

References 12 publications

Visual Diagnosis of Pleural Tuberculosis and its Association with Tissue Biopsy, Culture and Xpert Assay

Visual Diagnosis of Pleural Tuberculosis and its Association with Tissue Biopsy, Culture and Xpert Assay

Sago‐like appearance of pleura in Tuberculosis

Objective Thoracoscopic Criteria in Differentiation between Benign and Malignant Pleural Effusions

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