Diagnostic yield of medical thoracoscopy in diagnosis of exudative pleural effusion: One year prospective study

Abstract

Background: Differential diagnosis of pleural disease is often a lengthy process fraught with pitfalls. Contrary to thoracocentesis and closed pleural biopsy, thoracoscopy permits biopsy with direct visualization. Medical thoracoscopy increases the diagnostic yield in patients with pleural disease when thoracocentesis and closed pleural biopsy are non diagnostic.Aim of the work: This study investigated diagnostic yield of medical thoracoscopy for undiagnosed exudative pleural effusions over one year period.Patient and Methods: This study included 117 patients with undiagnosed exudative pleural effusions. All patients were subjected to written informed consent, full history taking, clinical examination, plain chest X-ray, CT chest and tuberculin skin test. Diagnostic pleural aspiration was done with pleural fluid chemical and cytological analysis. Patients with unhelpful pleural fluid analysis underwent medical thoracoscopy.Results: Regarding thoracoscopic pleural biopsy histopathology, out of 117 patients, 55 were diagnosed as malignant pleural mesothelioma, 26 diagnosed as metastatic adenocarcinoma, 1 diagnosed as spindle cell carcinoma, 5 diagnosed as lymphoma, 5 diagnosed as tuberculosis, 1 diagnosed

Comparison of Diagnostic Yield and Complications in Ultrasound-Guided Closed Pleural Biopsy Versus Thoracoscopic Pleural Biopsy in Undiagnosed Exudative Pleural Effusion

“…Medical thoracoscopy was performed in 19 patients, and ultrasound-guided pleural biopsy in 20 patients. In our study, the diagnostic yield of medical thoracoscopy was 94.7%, indicating a high yield in undiagnosed exudative pleural effusion, which is similar to the diagnostic yield of 90 to 97% reported in various studies [10][11][12][13]. A diagnostic yield of 66 to 97% has been reported in Indian studies [14][15][16][17][18].…”

Medical thoracoscopy in evaluation of undiagnosed pleural effusion

“…11 While Sabha et al, reported prolonged air leak in 0.85%, subcutaneous emphysema in 1.7%, wound infection in 0.85% and empyema in 1.71% of patients. 25 Both studies also reported no major complication or mortality.…”

“…24 In another study by Sabah et al, multiple nodules were the most common thoracoscopic finding (57.26%); other findings consisted of pleural masses (19.66%), adhesions (5.12%), diffuse pleural thickening (14.53%) and apparently healthy smooth pleura (2.56%). 25 In the study by Helala et al, all (100%) of the patients with adhesions had non-malignant lesion. Similarly, in the study by Prabhu et al, majority (96%) of the patients with adhesions had non malignant lesion.…”

Role of thoracoscopic pleural biopsy in evaluation of pleural effusion

“…Thoracoscopic pleural biopsy increases the diagnostic yield in patients with benign and malignant pleural disease. 6 The commonest malignant lesion in this study was adenocarcinoma constituting 13.2%. Pleural metastasis is more common than primary neoplasm.…”