Medical thoracoscopy, results and complications in 146 patients: a retrospective study

Abstract

In a retrospective study the results of medical thoracoscopy in 147 patients were reviewed; 136 of the patients had pleural effusion and 11 patients had diffuse pulmonary infiltration. All the pleural exudates were initially screened three times successively and found to be sterile and without tumour cells. All thoracoscopies were performed with local anaesthesia, with the 'open technique', and nine different doctors performed the thoracoscopies. The overall diagnostic sensitivity was 90.4%. The results demonstrated 62% with malignancy of the pleura, and 38% revealed benign pleural diseases, among them 2% with tuberculosis. The sensitivity for malignancy was found to be 88% and the specificity 96%. The most common primary lung cancer with involvement of the pleura was the adenocarcinoma (62%), and the most common metastatic tumour originated from the breast (28%). The sensitivity for tuberculosis was 100% and the specificity 100%. No mortality was found, and the morbidity was low at about 0.6% (empyema, pleuro-cutaneous fistula, transcutaneous growth of tumour (mesothelioma)). In 64% of the patients the thoracoscopy resulted in treatment (pleurodesis, antituberculous treatment, chemotherapy and peroral steroid therapy). The medical diagnostic thoracoscopy in local anaesthesia is a simple, low-cost investigation with a relatively high diagnostic accuracy, no mortality and a low morbidity.

Efficacy and Safety of Diagnostic Thoracoscopy in Undiagnosed Pleural Effusions

“…In the current study, the diagnosis of tuberculous pleural effusion was established by the presence of Mycobacterium tuberculosis in pleural biopsy specimen, or by demonstration of caseating granulomas and/ or epithelioid cell granulomas in pleural tissue with no evidence of other granulomatous diseases. As expected, in the present study, we observed that 40.0% (333/833) of the patients who underwent MT were confirmed to suffer from tuberculous pleural effusion, which was much higher than the 5.9% reported in the study from New Zealand [12] , the 5.6% from the United Kingdom [14] , the 3.2% from Spain [22] , the 2.7% from France [13] , the 2.0% from Denmark [23] , and even the 0% from the United States [24] .…”

Diagnostic Value and Safety of Medical Thoracoscopy in the Management of Exudative Pleural Effusion

“…Subcutaneous emphysema, localized infection of the incision site, hypotension, fever, atrial fibrillation during the procedure are minor; empyema, hemorrhage, tumor seeding in port site, bronchopleural fistula, pneumonia, prolonged air-leak and re-expansion pulmonary edema are the major complications reported from various studies (11). The complication rates in our study were similar to the literature; the post-operative hospitalization period was shorter in our study (Table 3) (4,8,(12)(13)(14)(15). The most common complication was subcutaneous emphysema; however, these patients had similar hospitalization days compared to the rest of the patients.…”

Propofol versus Midazolam in Medical Thoracoscopy: A Randomized, Noninferiority Trial

“…The main one is the fact that we used hypoxemia as a surrogate marker for morbidity and mortality instead of peri-interventional mortality as the endpoint of the study. However, due to the rarity of lethal complications in this setting (0.05-1%) [1,32,33], the estimated sample size for a study identifying a difference in mortality of 0.5% between the groups would be over 15,000 patients. Even a composite endpoint including relevant complications (incidence less than 3%) and tolerating a 2-fold higher incidence of adverse events (6%) would require over 1,500 patients.…”