Diagnostic value and safety of thoracoscopic pleural biopsies in pleural exudative effusions of unknown origin, including follow-up

Abstract

IntroductionPleural exudative effusions without diagnosis after initial work up are a frequent problem in any respiratory division. Several ways to obtain pleural biopsy exist. Thoracoscopy is one of the most frequently used. Differential diagnosis mainly exists out of malignant pleuritis, tuberculosis, nonspecific pleuritis and rarely systemic or autoimmune disease. We performed a retrospective data analysis of our almost 10-year period experience, the first Belgian data to be published.MethodsWe performed a retrospective data analysis of all patients with unexplained pleural exudates who underwent diagnostic medical thoracoscopy under general anaesthesia in our respiratory department during the period 2006–2015. We report on diagnoses made, sensitivity and specificity, safety of thoracoscopy and follow-up of patients after thoracoscopy.Results131 patients underwent diagnostic medical thoracoscopy during the inclusion period. 44.3% (n=58) of the patients were diagnosed with malignant pleuritis, 45.0% (n=59) with nonspecific pleuritis, 7.6% (n=10) with tuberculous pleuritis and some with other benign conditions. Complications are comparable to other data published. Six months follow-up of patients with non-specific pleuritis reveal 8.5% (n=5) of these patients to have malignant pleuritis, and another 8.5% (n=5) with infectious or other benign conditions.ConclusionMedical thoracoscopy under general anaesthesia for diagnostic work up of pleural exudates of unknown origin generally has a high diagnostic yield. It is generally safe, certainly compared with the information it delivers. During follow-up, minority of patients with nonspecific pleuritis will prove to be malignant in origin, benign or autoimmune disease related.

Mantle Cell Lymphoma Causing Recurrent Pleural Effusions: A Case Report

“…VATS, on the other hand, is associated with higher diagnostic yield, especially in the setting of pleural effusions of unknown etiology. Direct visualization allows for a more directed approach to obtaining tissue samples [ 20 , 21 ]. Yields can be as high as 97% via VATS procedures in exudative pleural effusions of unknown etiologies [ 21 ].…”

Unilateral green pleural effusion in a 22-year-old woman

“…pleural biopsy has a much higher diagnostic yield for malignancy 28 but it is not routinely performed owing to cost and the requirement for a specially trained surgeon or pulmonologist. 1 Although a cohort study of 34 patients reported a superior diagnostic yield of pleural biopsy compared with pleural fl uid analysis for the diagnosis of lymphoma, 29 pleural involvement in lymphoma is usually part of a systemic manifestation and is only rarely the primary source.…”

Ultrasound analysis of cervical thoracic duct for patients with constrictive pericarditis and chylothorax

“…Chylothorax is an accumulation of chyle around the lung due to lymphatic leakage or congenital or acquired etiology of chylous fluid flow. The incidence of chylothorax, about 2% of PE, is rising 1 . Chylothorax is observed often at the esophagus and mediastinum after surgery or trauma; spontaneous chylothorax is relatively rare and of unknown etiology.…”