Medical Thoracoscopy vs Closed Pleural Biopsy in Pleural Effusions: A Randomized Controlled Study

Haridas, Nithya; Chetambath, Ravindran

doi:10.7860/jcdr/2014/7476.4310

Cited by 33 publications

(37 citation statements)

References 12 publications

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“…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.…”

Section: Discussionsupporting

confidence: 85%

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

Özgül¹,

Çetınkaya²,

Tanrıverdi³

et al. 2017

Eurasian J Pulmonol

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Objective: Medical thoracoscopy is a minimally invasive procedure that is performed by experienced pulmonologists under local anesthesia and conscious intravenous sedation. It allows direct observation and evaluation of the pleural space. Our aim is to evaluate the diagnostic efficacy and safety of this procedure while presenting our results of medical thoracoscopy performed by rigid thoracoscopy in our clinic. Methods:Thirty-seven patients who had gone thorough medical thoracoscopy between March 2011 and August 2014 were evaluated retrospectively.Results: Of these 37 patients, 26 were male and the average age was 50.94±15.38 years. Fourteen patients had right-sided pleural effusion, whereas 23 had left-sided pleural effusion. Closed pleural biopsy was performed previously in 16 patients with no diagnostic results. In 36 patients (97.3%), a specific diagnosis was achieved. One patient, diagnosed as lymphocytic pleuritis by medical thoracoscopy, underwent decortication and the pathology was consistent with biphasic malignant pleural mesothelioma. Another patient, diagnosed as chronic nonspecific pleuritis with medical thoracoscopy, underwent decortication and the diagnosis was fibrinous pleuritis characterized by extensive fibrosis. Three patients had expansion defects during the post-operative period. Hemothorax occurred in one patient that died of respiratory failure on day 34 of hospitalization. The median length of stay in the hospital after the procedure was 5 days (1-34). Conclusion:Medical thoracoscopy is a secure procedure with high diagnostic value in the management of exudative pleural effusion.

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Section: Discussionsupporting

confidence: 85%

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

Özgül¹,

Çetınkaya²,

Tanrıverdi³

et al. 2017

Eurasian J Pulmonol

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“…The diagnostic sensitivity in previous thoracoscopic studies varied from 66% to 100%. 13,23,24 The sensitivity of thoracoscopic pleural biopsy for malignancy in present study was 92.8% and for TB was 100%. This result is comparable with the study by Sakuraba et al who studied 138 patients and reported a diagnostic efficacy of 92.6% in the cases of carcinoma, and in tuberculosis it was 93.8%.…”

Section: Figure 1: Distribution Of Agementioning

confidence: 47%

“…The non-occurrence of major complications may be because of less number (<5) of biopsies. 13,15 The sensitivity obtained for FOB was 3 out of 21 cases (14.2%) but the specificity was 100%. Very few studies were available for bronchoscopy in pleural effusion cases.…”

Section: Figure 1: Distribution Of Agementioning

confidence: 93%

Comparison of diagnostic yield and complications of bronchoscopy, closed pleural biopsy and medical thoracoscopic pleural biopsies in undiagnosed pleural effusions

et al. 2017

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INTRODUCTIONPleural effusion is the abnormal accumulation of fluid in the pleural space. It can be transudate or exudates and Light's criteria help to differentiate them.1 Exudative pleural effusion is a commonly encountered clinical scenario among both respiratory and non-respiratory specialists. In humans, approximately 75% of the cells in the pleural fluid are macrophages, 25% are lymphocytes and mesothelial cells, neutrophils and eosinophils accounting for less than 2% each.2 The precise pathophysiology of fluid accumulation vary based upon ABSTRACT Background: Undiagnosed exudative pleural effusion is a commonly encountered clinical scenario, which requires further evaluation. This study was aimed to analyze the diagnostic yield and complications of three proceduresBronchoscopy, closed (Abram's) pleural biopsy and medical thoracoscopy. Further, this study assessed whether combining closed pleural biopsy with bronchoscopy can be a substitute for medical thoracoscopy. Methods: An observational study was conducted among people with undiagnosed exudative pleural effusion. Initially, closed pleural biopsies were performed with Abrams needle and multiple tissue fragments were taken through the incision and the samples were sent in formalin to the laboratory for histopathology examination. For thoracoscopy, a cannula of 10 mm diameter with blunt trocar was inserted into the pleural cavity and semi rigid thoracoscope was introduced through the trocar. Bronchoscopy was performed 48 hours after thoracoscopy. Sensitivity, specificity and positive and negative predictive values were calculated and compared. Results: Out of 25 people, 14 were diagnosed to have malignancy and 7 were diagnosed tuberculosis. The overall sensitivity of the three procedures were 28.5% for closed pleural biopsy, 14.2% for bronchoscopy, 95.2% for medical thoracoscopy, 42.8% for the combined pleural biopsy and bronchoscopy. The complication rate was lowest for bronchoscopy (4%), followed by medical thoracoscopy (8%) and closed pleural biopsy (16%). Conclusions: Medical thoracoscopy is a comparatively safe procedure which has got the highest sensitivity for the diagnosis of undiagnosed exudative pleural effusions. Bronchoscopy combined with closed pleural biopsy, the diagnostic yield was increased (than that of individual yield), but cannot be a substitute for medical thoracoscopy.

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“…4 Moreover, in a recent randomized controlled trial comparing the efficacy of closed pleural biopsy and MT in the diagnosis of exudative pleural effusion of unknown etiology, MT had a diagnostic yield of 86% and complication rate of 10% compared to closed pleural biopsy (62% and 17%, respectively). 19 Thus, despite repeated pleural fluid sampling and closed pleural biopsy, the etiology of pleural effusion remains unknown in up to 25% to 40% of patients. 20,21 In a systematic review evaluating the diagnostic accuracy of MT for patients with pleural effusion of undetermined etiology, MT (semirigid) had a pooled sensitivity and specificity of 97% and 100%, respectively.…”

Section: Clinical Applications Exudative Pleural Effusion Of Unknown mentioning

confidence: 99%

“…The diagnostic yield of MT is around 95% in patients with MPE and has a success rate of 90% in achieving pleurodesis. 19 Medical thoracoscopy is considered a less invasive procedure compared to VATS, requires moderate sedation, requires a single port of entry, and can be done in the endoscopy suite. Although rigid MT can obtain a larger specimen, the diagnostic yield of rigid and flex-rigid is similar in malignant pleural disease.…”

Section: Malignant Pleural Effusionmentioning

confidence: 99%