Medical thoracoscopy in the diagnosis of pleural disease: a guide for the clinician

Shaikh, Faisal; Lentz, Robert J.; Feller‐Kopman, David; Maldonado, Fabien

doi:10.1080/17476348.2020.1788940

Cited by 16 publications

(9 citation statements)

References 134 publications

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“…Unlike thoracocentesis and CPB, MT permits biopsy for suspicious lesions with direct visualization to improve the diagnostic yield of pleural effusion, which can be targeted accurately [25]. In our study, single or multiple nodules (89.6%) were the most ndings under MT, following by pleural adhesions (34.0%).…”

Section: Discussionmentioning

confidence: 65%

Diagnostic Value And Safety of Medical Thoracoscopy In The Pleural Effusion of Different Causes

Lv¹,

XiLin²,

Fang³

et al. 2021

Preprint

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Background: Pleural effusions are caused by various reasons, whose diagnosis remains challenging in spite of various means of diagnosis. Medical thoracoscopy, greatly improves the diagnostic efficacy and gets preference for managements, especially undiagnosed pleural effusions. This study aimed to assess the diagnostic efficacy and safety of medical thoracoscopy in patients with pleural effusion of different causes. Methods: Between January 1st 2012 and April 30th 2021, patients with pleural effusion underwent medical thoracoscopy in the Department of Respiratory Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University. According to the discharge diagnosis, patients were grouped into three, including malignant, tuberculous and inflammatory group. General information, tuberculosis-related and effusion-related indices of three groups were analyzed. The diagnostic yield, diagnostic accuracy, performance under thoracoscopy and complications of patients were compared in three groups. Then, the significant factors for predictive diagnosis between the malignant and tuberculous group were analyzed. Results: During this 10-year study, 106 patients were included, with 67 males and 39 females, mean age 57.1±14.184 years. In 74 patients confirmed under thoracoscopy, 41 patients (38.7%) were malignant, 21 patients (19.8%) tuberculous and 32 patients (30.2%) undiagnostic. The diagnostic yield of medical thoracoscopy is 69.8%, and 75.9% in the malignant, 48.8% in the tuberculous, and 75.0% in the inflammatory. The diagnostic accuracies are 100%, 87.5%, and 75.0%, respectively. Under thoracoscopy, we observed single or multiple pleural nodules in 81.1%, pleural adhesions in 34.0% of patients with pleural effusions. The most common complication was chest pain (41.5%), following by chest tightness (11.3%), fever (10.4%). Multivariate logistic regression analysis showed that effusion appearance (OR=0.001, 95%CI: 0.000-0.204, P=0.010), CEA (OR=0.243, 95%CI: 0.081-0.728, P=0.011) were significant in the differentiation of malignant and tuberculous pleural effusion. Conclusion: Medical thoracoscopy is an effective, safe, less invasive procedure with high diagnostic yield for the pleural effusion of different causes. Medical thoracoscopy has a promising prospect.

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Section: Discussionmentioning

confidence: 65%

Diagnostic Value And Safety of Medical Thoracoscopy In The Pleural Effusion of Different Causes

Lv¹,

XiLin²,

Fang³

et al. 2021

Preprint

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“…Conventional histopathologic presence of M. tuberculosis on culture, or pleural pathology showing caseating granuloma is the gold standard for diagnosing TPE, however, the diagnostic tests were time consuming and low positive rate [8,11]. Tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) were two common detection methods for diagnosing TPE, but the limitations of inaccuracy, inconsistent sensitivity, and time to diagnosis have retained its efficacies [11,15,16].…”

Section: Discussionmentioning

confidence: 99%

“…Tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) were two common detection methods for diagnosing TPE, but the limitations of inaccuracy, inconsistent sensitivity, and time to diagnosis have retained its efficacies [11,15,16]. Under the circumstances, thoracoscopy seemed to provide a higher sensitivity (93-100%) and accuracy for diagnosing TPE, however, it was an invasive and expensive diagnostic method with a reported 2-6% rate of complications [8,17,18]. The common complications were bleeding, fever, empyema, pneumonia, and prolonged air leak and so on [18].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, the gold standards for TPE diagnosis were based on the detection of acid-fast bacilli (AFB) in sputum, pleural fluid, or pleural biopsy tissues through Mycobacterium tuberculosis (M. tuberculosis) culture or performed by thoracoscopy [4,5]. However, the limited sensitivity, low accuracy and invasive examination of those diagnostic tools compromised their diagnostic value in clinical practice [6][7][8]. Alternative diagnostic methods, including tuberculin skin test (TST), adenosine deaminase (ADA), and interferon-gamma release assays (IGRAs), have improved the speed for TPE diagnosis in recently years [4,[9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Development and validation of a prediction model for tuberculous pleural effusion: a large cohort study and external validation

et al. 2022

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Background Distinguishing tuberculous pleural effusion (TPE) from non-tuberculosis (TB) benign pleural effusion (BPE) remains to be a challenge in clinical practice. The aim of the present study was to develop and validate a novel nomogram for diagnosing TPE. Methods In this retrospective analysis, a total of 909 consecutive patients with TPE and non-TB BPE from Ningbo First Hospital were divided into the training set and the internal validation set at a ratio of 7:3, respectively. The clinical and laboratory features were collected and analyzed by logistic regression analysis. A diagnostic model incorporating selected variables was developed and was externally validated in a cohort of 110 patients from another hospital. Results Six variables including age, effusion lymphocyte, effusion adenosine deaminase (ADA), effusion lactatedehy drogenase (LDH), effusion LDH/effusion ADA, and serum white blood cell (WBC) were identified as valuable parameters used for developing a nomogram. The nomogram showed a good diagnostic performance in the training set. A novel scoring system was then established based on the nomogram to distinguish TPE from non-TB BPE. The scoring system showed good diagnostic performance in the training set [area under the curve (AUC) (95% confidence interval (CI)), 0.937 (0.917–0.957); sensitivity, 89.0%, and specificity, 89.5%], the internal validation set [AUC (95%CI), 0.934 (0.902–0.966); sensitivity, 88.7%, and specificity, 90.3%], and the external validation set [(AUC (95%CI), 0.941 (0.891–0.991); sensitivity, 93.6%, and specificity, 87.5%)], respectively. Conclusions The study developed and validated a novel scoring system based on a nomogram originated from six clinical parameters. The novel scoring system showed a good diagnostic performance in distinguishing TPE from non-TB BPE and can be conveniently used in clinical settings.

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“…A pleural biopsy or thoracoscopy is required when effusion cytology is negative and malignancy remains the suspected cause of PE 10 . Image‐guided pleural biopsy and thoracoscopy have high accuracy for MPE, 10–12 but they are invasive and can cause operation‐related complications such as pain, subcutaneous hematoma and infection 13–16 . In addition, special training is needed for thoracoscopy, limiting its application in remote areas.…”

Section: Introductionmentioning

confidence: 99%

Long‐term stability of pleural fluid carcinoembryonic antigen and its effect on the diagnostic accuracy for malignant pleural effusion

et al. 2023

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Background: The in vitro stability assessment is essential for investigating the diagnostic accuracy of pleural biomarkers. This study aimed to investigate the long-term stability of pleural fluid carcinoembryonic antigen (CEA) at À80 C to À70 C. In addition, we analyzed the effects of frozen storage on the diagnostic accuracy of CEA for malignant pleural effusion (MPE). Methods: Pleural fluid CEA of participants in two prospective cohorts were stored at À80 C to À70 C for 1-3 years. The CEA level in the stored specimen was measured with an immunoassay, and its level in the fresh specimen was extracted from medical records. The Bland-Altman method, Passing-Bablok regression, and Deming regression were used to analyze the agreement of CEA between the fresh and frozen pleural fluid. In addition, we used receiver operating characteristic (ROC) curves to evaluate the diagnostic accuracy of CEA in the fresh and frozen specimens for MPE. Results: A total of 210 participants were enrolled. The median CEA levels in frozen and fresh pleural fluid specimens were similar (frozen, 2.32 ng/mL; fresh, 2.59 ng/mL; p < 0.01). The slopes and intercepts in the Passing-Bablok regression (intercept 0.01, slope 1.04) and Deming regression (intercept 0.65; slope 1.00) were not statistically significant (p > 0.05 for all). No significant difference was observed between the area under the ROC curves of CEA in the fresh and frozen specimens (p > 0.05 for all). Conclusion: Pleural fluid CEA is seemingly stable when stored at -80 C to À70 C for 1-3 years. Frozen storage does not significantly affect the diagnostic accuracy of CEA for MPE.

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Medical thoracoscopy in the diagnosis of pleural disease: a guide for the clinician

Cited by 16 publications

References 134 publications

Diagnostic Value And Safety of Medical Thoracoscopy In The Pleural Effusion of Different Causes

Diagnostic Value And Safety of Medical Thoracoscopy In The Pleural Effusion of Different Causes

Development and validation of a prediction model for tuberculous pleural effusion: a large cohort study and external validation

Long‐term stability of pleural fluid carcinoembryonic antigen and its effect on the diagnostic accuracy for malignant pleural effusion

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