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

Shrestha, Bishow Kumar; Adhikari, Shital; Thakur, Basant Kumar; Kadaria, Dipen; Tamrakar, Kishor Kumar; Devkota, Mukti

doi:10.31729/jnma.4873

Cited by 4 publications

(1 citation statement)

References 8 publications

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“…No complications were observed in 58.9% of cases, thus establishing the safety of the procedure in high-risk patients [ 31 ]. Mild to moderate pain and minor bleeding were described in another study of 14 patients with an overall diagnostic yield of 100% [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

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)

Allocca,

Guidelli,

Galgano

et al. 2024

Diagnostics

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Introduction: Medical pleuroscopy (MP) is an invasive technique that provides access to the pleural space with a rigid or semi-rigid work instrument, allowing for visualization and the obtaining of bioptic pleural samples. Using pulmonologist-based analgosedation to perform pleuroscopy is still debated for safety reasons. The aim of this real-life study is to demonstrate the safety and diagnostic yield of MP performed under balanced analgosedation by a pulmonologist team with expertise in the management of critically ill patients in the respiratory intensive care unit (RICU) and interventional pulmonology unit as compared to video-assisted thoracic surgery (VATS) performed by a thoracic surgeon team under anesthesiologist-based analgosedation. Methods: In this multicentric retrospective controlled study, the inclusion criteria were patients older than 18 years old with pleural effusion of unknown diagnosis consecutively admitted in the years 2017–2022 to the pulmonology unit and RICU of San Donato Hospital in Arezzo (Italy, Tuscany) and to the thoracic surgery unit of Santa Maria Le Scotte in Siena (Italy, Tuscany) to undergo, respectively, MP under balanced propofol-based analgosedation on spontaneous breathing with local anesthesia provided by a pulmonologist team (Group A), and VATS provided by a surgeon team under propofol-based analgosedation managed by an anesthesiologist using invasive mechanical ventilation (IMV) via endotracheal intubation (ETI) (Group B). The primary endpoints were (1) a comparison between the two groups in terms of the diagnostic yield of pleural effusion, and (2) major and minor complications of pleuroscopic procedures. The secondary endpoints were (1) the length of the pleuroscopic procedure; (2) the duration of hospitalization; (3) propofol doses; and (4) the patient’s comfort after the procedure assessed using the Visual Analogue Scale (VAS). Results: We enrolled 91 patients in Group A and 116 patients in Group B. A conclusive diagnosis was obtained in 97.8% of Group A vs. 100% of Group B (p = 0.374). Malignant effusion was diagnosed in 59.3% of Group A and in 55.1% of Group B; p = 0.547. No intraoperative or postoperative mortality events or major complications were observed in Group A. The major complications observed in Group B were three major bleeding events (p = 0.079) and one exitus (p = 0.315) not related to the interventional procedure. No significant difference emerged between the two groups in terms of minor complications. The duration of the intervention was significantly lower in Group A (40.0 min ± 12.6 versus 51.5 ± 31.0; p = 0.001). Pain control and, therefore, patient comfort were better in Group A, with an average VAS of 0.34 ± 0.65 versus 2.58 ± 1.26, p < 0.001. The duration of hospitalization was lower in Group B (5.1 ± 2.6 vs. 15.5 ± 8.0, p < 0.001). The average overall dose of propofol administered was significantly lower in Group A (65.6 ± 35.8 mg versus 280 ± 20.0 mg; p < 0.001). Conclusions: This real-life study shows that the MP performed under propofol-based analgosedation by an independent pneumologist team is a safe and well-tolerated procedure with a diagnostic yield and complication rates similar to those obtained with VATS.

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Section: Discussionmentioning

confidence: 99%

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)

Allocca,

Guidelli,

Galgano

et al. 2024

Diagnostics

View full text Add to dashboard Cite

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Diagnostic value and safety of medical thoracoscopy for pleural effusion of different causes

Liu¹,

Dong²,

Fang³

et al. 2022

WJCC

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Role of Flexi-Rigid Thoracoscopy in Undiagnosed Pleural Effusions and Correlation of Visual Appearance of Pleura on Thoracoscopy with the Final Diagnosis

Periwal,

Khanna,

Talwar

2021

Journal of Association of Pulmonologist of Tamil Nadu

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Background: Undiagnosed pleural effusions (UPE) account for roughly 25% of cases of all pleural effusions. Minimally invasive flexi-rigid thoracoscopy has high diagnostic yield. Some previous studies have looked into the correlation of the thoracoscopic findings and the final etiological diagnosis, however, data are scarce. This study is aimed to know the role of flexi-rigid thoracoscopy in establishing etiological diagnosis in undiagnosed, treatment naïve pleural effusion patients and the correlation of thoracoscopic findings with the final diagnosis. Materials and Methods: A retrospective descriptive observational study was conducted on 84 newly diagnosed patients in whom pleural effusion remained undiagnosed at the Department of Respiratory, Sleep, Allergy and Critical Care Medicine at the Metro Centre for Respiratory Diseases, Metro Hospital, Noida. Data from hospital records of patients, who were subjected to flexi-rigid thoracoscopy, was collected between January 2010 and December 2013 and analyzed. The diagnostic yield of pleural biopsy using flexi-rigid thoracoscope in UPEs was assessed and the visual appearance of pleura on thoracoscopy was correlated with the final diagnosis. Results: The diagnostic yield of flexi-rigid thoracoscopy in UPEs is 89.28%. When nonspecific pleuritis is considered as a diagnosis, the diagnostic yield increases to 97.6%. The pleural biopsy histopathological examination revealed Nonspecific pleuritis in 14.2% of patients, granuloma consistent with tuberculosis (TB) in54.8%, malignancy in 28.6% of patients confirmed on immunohistochemistry and in 2.3% the diagnosis remained inconclusive. Out of the 12 patients, two were diagnosed to have TB on the basis of pleural biopsy acid-fast bacilli culture showing mycobacterium TB. Post coronary artery bypass graft pleuropericardial effusion, chylothorax, and congestive heart failure were diagnosed in 1 case each, while the diagnosis remained uncertain in 7. The thoracoscopic finding of adhesions had negligible and no statistically significant correlation to the final diagnosis. The presence of pleural nodularity had a negative correlation with nonspecific pleuritis and a positive correlation with malignancy although statistically insignificant. It was seen that small and uniform nodules had a positive correlation with TB. The presence of large and variable-sized nodules had a strong positive correlation with malignancy. The presence of diaphragmatic nodules has a positive correlation with malignancy. Pleural infiltration has a strong positive correlation with malignancy and negative correlation with TB. Conclusion: Flexi-rigid pleuroscopy is an excellent modality to investigate UPE since it has a high diagnostic yield, is minimally invasive and safe procedure. The presence of a variable distribution of nodules, large nodules, diaphragmatic nodules, visceral pleural infiltration has a strong positive correlation with malignancy and increases the likelihood of malignancy as the final diagnosis. However, the visual appearance of the pleura is a subjective finding and possibly more informative when used by an experienced pulmonologists in combination with the pleural biopsy for the final diagnosis.

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

Cited by 4 publications

References 8 publications

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)

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)

Diagnostic value and safety of medical thoracoscopy for pleural effusion of different causes

Role of Flexi-Rigid Thoracoscopy in Undiagnosed Pleural Effusions and Correlation of Visual Appearance of Pleura on Thoracoscopy with the Final Diagnosis

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