Medical thoracoscopy: Analysis on diagnostic yield through 30 years of experience

Abstract

BACKGROUND:Medical thoracoscopy (MT) or pleuroscopy is a procedure performed to diagnose and treat malignant and benign pleural diseases. Totally 2752 pleuroscopies executed in 1984–2013 in our center were considered in this study.METHODS:A retrospective observational study was performed. Observational time was divided into six series of 5 years. We calculated MT diagnostic yield and analyzed trends of main diseases diagnosed along the time.RESULTS:Along the 30 years population became progressively older. Number of pleuroscopies firstly increased, then stabilized and decreased in the last 5 years. The overall diagnostic yield of MT was 71%, increasing from 57% to 79%. The diagnostic yield was significantly higher in the presence of monolateral pleural effusion. Cancer represented more than half of diagnosis; tuberculosis was the most common nonneoplastic disease. The frequency of all cancers, mesothelioma, and lung cancer increased through the time; tuberculosis first decreased and then increased. All specimens resulted appropriate during the last 25 years.CONCLUSION:MT has a great diagnostic yield that can be improved by practice, permitting to achieve a specific histological diagnosis in about 80% of patients. Our experience demonstrates that the accurate selection of the patients undergoing to MT is very important to reach these results.

Safety and Diagnostic Yield of Medical Pleuroscopy (MP) Performed under Balanced Analgosedation by a Pneumological Team Compared to Video-Assisted Thoracic Surgery (VATS): A Retrospective Controlled Real-Life Study (TORAPO)

“…No deaths and no major complications, either intraoperative or postoperative, were observed in the MP group. These results are in line with literature [ 23 , 24 , 25 , 26 ]. In the retrospective observational study of Valsecchi et al on 2752 analyzed MPs, the diagnostic yield was about 80%, and in more than half of the cases, the diagnosis was consistent with malignancies.…”

Medical Thoracoscopy for Undiagnosed Exudative Pleural Effusion: A Descriptive Cross-sectional Study

“…The overall diagnostic yield in this study was 100%, which was comparable to several studies. 3 , 7 – 10 However, our yield was somewhat higher (reached 100%) than that reported by some other studies. The reasons for this high yield could be smaller sample size and all patients having unilateral exudative pleural effusion.…”

“…Rigid thoracoscope has the disadvantage of less manoeuvrability, which can be more so when the rib spaces are narrower. Relatively larger biopsy forceps than in semi-rigid thoracoscope, introduced through the second port could have given larger biopsy material, 10 but at the cost of slightly increased pain and bleeding.…”

Surgical Diagnosis of Malignant Pleural Mesothelioma: 20 Years’ Experience at a High-Volume Referral Center

“…However, the 3.7% rate of redo surgery for diagnostic failure highlights the complexity of pathological assessment and the usefulness of large pleural sampling, especially in the era of molecular and tumor microenvironment analyses [ 5 , 24 , 25 ]. Moreover, it should be noted that “classical” medical thoracoscopy has also been reported as a relevant and reasonable alternative for pleural biopsy and simultaneous talc poudrage, nevertheless exhibiting lower efficiency than surgical procedures in reaching both diagnostic and therapeutic objectives [ 26 ].…”