scholarly journals Aspect of Thoracoscopic Biopsy in Pleural Malignancy

2021 ◽  
Vol 10 (42) ◽  
pp. 3649-3653
Author(s):  
Priyanka Joshi ◽  
Rajdeep Dhandhukiya ◽  
Sheema Maqsood ◽  
Vijay Bhargava
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Diagnostic Yield ◽  
Smoking Status ◽  
Pulmonary Medicine ◽  
Pleural Effusions ◽  
Pleural Diseases ◽  
Medical College ◽  
Medical Thoracoscopy ◽  
Thoracoscopic Biopsy

BACKGROUND Medical thoracoscopy, in the educated fingers of a pulmonologist, is a secure and powerful process for the diagnosis and treatment of many pleural diseases. If the centres for thoracoscopy are available, thoracoscopy should be carried out on those undiagnosed sufferers due to its excessive sensitivity in malignant and tuberculous pleural effusions. That is why the ultimate decade witnessed an interest in thoracoscopy as a diagnostic device for pleural diseases. In the existing study, we wanted to describe our experience with the function of thoracoscopic biopsy in patients who underwent thoracoscopy for diagnostic purposes. METHODS The study protocol and ethical approval were taken by the Institutional Review Board for human studies of B. J. Medical College, Gujarat. It was a prospective study conducted in the Department of Pulmonary Medicine, B. J. Medical College, Ahmedabad, between July 2014 and November 2016. 39 patients who underwent medical thoracoscopy for undiagnosed pleural effusions were enrolled in this study. Undiagnosed pleural effusion was defined as failure to achieve a diagnosis by initial pleural fluid analysis including pleural fluid adenosine deaminase (ADA) levels and at least three pleural fluid analyses negative for malignant cells. Diagnostic pleural fluid aspiration was done to obtain pleural fluid specimens. RESULTS In the present study with the help of thoracoscopy, 36 (92.31 %) patients were diagnosed successfully while only 3 patients remained undiagnosed. In the present study, on thoracoscopic examination 21 (53.85 %) patients had pleural nodules, 5 (12.82 %) patients had pleural thickening, 5 (12.82 %) patients had pleural plaquelike erythema. The remaining patients had other uncommon findings e.g. nonspecific pleuritis 3 (7.69 %). CONCLUSIONS Among all the patients with undiagnosed exudative pleural effusion, irrespective of smoking status which fails to respond to conventional medical management, diagnostic thoracoscopy should be considered as early as possible. The diagnostic yield of thoracoscopy for pleural pathology remains very high (92.3 %). KEYWORDS Diagnosis, Malignant Pleural Effusion, Thoracoscopy.

scholarly journals Diagnostic Yield of Medical Thoracoscopy in Undiagnosed Exudative Pleural Effusion- A Tertiary Centre Experience from Aligarh Muslim University, Uttar Pradesh, India

2020 ◽  
Author(s):  
Mohammad Arif ◽  
Rakesh Bhargava ◽  
Mohammad Shameem ◽  
Nafees Ahmad Khan ◽  
Sadaf Sultana
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Histopathological Examination ◽  
Diagnostic Yield ◽  
Uttar Pradesh ◽  
P Value ◽  
Fisher Exact Test ◽  
Pulmonary Medicine ◽  
Medical Thoracoscopy ◽  
Exudative Pleural Effusion

Introduction: Pleural effusions are one of the most common entities encountered by pulmonologists worldwide which have a very long list of causes. Initial workup of these patients begins with a chest X-ray and percutaneous or Ultrasound (USG) guided thoracocentesis followed by biochemical and cytological evaluation of the fluid to ascertain the cause of effusion. A 20 to 25% of cases remain undiagnosed even after thoracocentesis and closed pleural biopsy. Medical Thoracoscopy is emerging as a safe diagnostic procedure in these patients. Aim: To detect the diagnostic yield of medical thoracoscopy in cases of undiagnosed exudative lymphocytic pleural effusion and to study the complications associated with it. Materials and Methods: This was a prospective observational study, carried out in the Department of Pulmonary Medicine, JN Medical College and hospital, Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, India, from August 2016 to August 2018. Undiagnosed exudative pleural effusion was defined as pleural effusion with Adenosine Deaminase (ADA) levels less than 70 IU/L and negative pleural fluid cytology for malignancy. Thoracoscopic examination of the pleural space using flexi-rigid thoracoscopy was done and biopsy was taken from suspected areas and the tissue obtained, was send for histopathological examination. The results were presented as mean±SD (Standard Deviation) or percentage. Differences in categorical data were compared using the chi-square test or the Fisher-exact test. A p-value of <0.05 was considered statistically significant. Results: Fifty patients underwent thoracoscopy for undiagnosed pleural effusion. Most common gross thoracoscopy finding was nodules which was seen in 23 patients. Malignancy was the most common histopathological finding, seen in 22 patients. Minor complications were seen in five patients. A final diagnosis could be made in 41 patients; the diagnostic yield was 82%. Conclusion: Medical thoracoscopy should be performed in all patients in which radiological and pleural fluid examinations could not lead to a definitive diagnosis as it has high sensitivity and a very low rate of complications.

scholarly journals Medical thoracoscopy- an experience

2017 ◽  
Vol 5 (5) ◽  
pp. 2176
Author(s):  
Naveed Nazir Shah ◽  
Nazia Mehfooz ◽  
Syed Suraya Farooq ◽  
Khurshid A. Dar ◽  
. Shumayl ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Yield ◽  
Invasive Procedure ◽  
Cost Effective ◽  
Pleural Diseases ◽  
Medical College ◽  
Medical Thoracoscopy ◽  
Chest Disease ◽  
Disease Hospital ◽  
Exudative Pleural Effusion

Background: Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating pleural diseases especially undiagnosed exudative pleural effusion. It is cost effective and safe. The diagnostic yield in undiagnosed pleural effusion is excellent.Methods: This prospective observational study was done in Government Chest Disease hospital of Government Medical College, Srinagar during the period between December 2015 to Dec 2016.Thirty undiagnosed pleural effusion patients after thoracocentesis and who fulfilled inclusion and exclusion criteria’s were included in the study. Medical thoracoscopy using rigid thoracoscope was started for the first time in our hospital and was done in these enrolled patients. Clinical, Thoracoscopic findings and histopathological data of the patients were collected prospectively and analysed.Results: Maximum patients were in the age group of 41-50 years. Most common Thoracoscopic finding was multiple nodules (40%) followed by sago grain infiltration (33.4%). Malignancy was the most common HPE finding of pleural biopsy (46.6%) followed by TB (33.3%). All nodules (13) turned out to be malignant while all sago grain appearance pleura (10) turned out of to be TB. The overall diagnostic yield is 80% as a whole and 96% among patients who had thoracoscopic pleural findings.Conclusions: Medical Thoracoscopy is a safe and easy outpatient procedure and an excellent diagnostic tool for undiagnosed exudative pleural effusion. The diagnostic yield is quite high and complications of procedure are negligible.

scholarly journals The value of exfoliative cell cytology in the diagnosis of exudative pleural effusions

2018 ◽  
Vol 88 (3) ◽  
Author(s):  
Cuneyt Tetikkurt ◽  
Nail Yılmaz ◽  
Seza Tetikkurt ◽  
Şule Gundogdu ◽  
Rian Disci
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Diagnostic Yield ◽  
Final Diagnosis ◽  
Exfoliative Cytology ◽  
Pleural Effusions ◽  
Cytologic Examination ◽  
Collagen Vascular Diseases ◽  
Female Ratio ◽  
Exudative Pleural Effusion

The sensitivity and specificity of exfoliative cell cytology for the diagnosis of exudative pleural effusions varies widely according to the etiologic causes. The aim of this study is to assess the diagnostic value of exfoliative cell cytology for the identification of exudative pleural effusions. This is a retrospective study of the patients with an exudative pleural effusion admitted at our clinic in the last twenty years. We have conducted the clinical, the cytological findings, and the diagnostic results of six hundred patients from hospital records.  Male to female ratio was 2.2:1 with a mean age of 42.8 years (range 18-78 years) among the patients. Samples were processed and evaluated according to the standard methods. Cytology results were reviewed and the patients were stratified according to the final diagnosis of their disease. Of the six hundred exudative effusions, 240 were malignant on exfoliative cytology pleural fluid alone. Adenocarcinoma was the most common type of malignancy. Tuberculosis was the second most frequent etiology for the exudative effusions followed by infection and collagen vascular diseases. Diagnostic accuracy of cytology showed a good correlation with the final diagnosis with an overall 70.1% sensitivity, 62.5% specificity, and a 95.9% positive predictive value for all exudative pleural effusions. Cytologic examination of the pleural fluid is a simple non-invasive procedure as the initial step for the diagnostic work up of patients with a pleural effusion.  Exfoliative cytology provides high a final diagnostic yield for the identification of an exudative pleural effusion etiology. Furthermore, cytologic analysis leads the clinician into the correct diagnostic pathway as the most informative laboratory tool even when it was not diagnostic by itself for equivocal cases.

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

2021 ◽  
Author(s):  
Xiaoting Liu ◽  
Xilin Dong ◽  
Yu Zhang ◽  
Ping Fang ◽  
Hongyang Shi ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Yield ◽  
Multivariate Logistic Regression Analysis ◽  
Invasive Procedure ◽  
Diagnostic Value ◽  
General Information ◽  
Pleural Effusions ◽  
Predictive Diagnosis ◽  
Diagnostic Efficacy ◽  
Medical Thoracoscopy

Abstract 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.

scholarly journals Role of adenosine deaminase in monitoring tubercular pleural effusion

2019 ◽  
Vol 6 (6) ◽  
pp. 2426
Author(s):  
Basanta Hazarika ◽  
Suresh Sharma ◽  
Ritesh Kumar ◽  
Jogesh Sarma
Keyword(s):  
Pleural Effusion ◽  
Adenosine Deaminase ◽  
Pleural Fluid ◽  
Malignant Cell ◽  
P Value ◽  
Pulmonary Medicine ◽  
Medical College ◽  
Microbiological Parameters

Background: Tuberculosis is a common cause of pleural effusion especially in countries like India. ADA (adenosine deaminase) is predominantly an enzyme, that catalyses the conversion of adenosine to ionosine. Usually patients with tuberculous pleural effusion have ADA level >40 U/L.Methods: This is a prospective, observational study conducted in Department of Pulmonary Medicine, Gauhati Medical College and Hospital, Guwahati from September 2016 to September 2017. 45 patients with pleural fluid ADA levels >40 U/L were selected with diagnosis of tubercular pleural effusion. Pleural fluid was analysed for cytological, biochemical and microbiological parameters along with ADA and malignant cell cytology. Anti-tubercular treatment (ATT) was started and pleural fluid ADA level were repeated after 15 days of ATT.Results: Pleural fluid ADA levels before the start of ATT intake and after 15 days of ATT intake were statistically analysed. Among 45 patients, 38 were male and 7 females.  Mean age of the patients was 45.42±16.43 years. Mean pleural fluid ADA level before starting ATT was 64.49±31.78 U/L. After 15 days of ATT intake mean pleural fluid ADA level was 36.11±10.42 U/L, p value was statistically significant (p<0.05).Conclusions: Pleural fluid ADA significantly decreased after 15days of initiation of anti-tubercular treatment. Pleural fluid ADA can be a useful tool as a follow up biomarker in cases of tubercular pleural effusion. 

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

2017 ◽  
Vol 5 (2) ◽  
pp. 388
Author(s):  
Kizhakkepeedika Davis Rennis ◽  
Jaboy Bibin ◽  
Vadakkan Thomas ◽  
Easwaramangalath Venugopal Krishnakumar
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Yield ◽  
Safe Procedure ◽  
Pleural Effusions ◽  
Pleural Biopsy ◽  
Predictive Values ◽  
Medical Thoracoscopy ◽  
Sensitivity Specificity ◽  
Blunt Trocar ◽  
Exudative Pleural Effusion

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 procedures- Bronchoscopy, 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.

Diagnostic efficacy and suitability of trans-thoracic ultrasonography for pleural fluid detection – The future non-invasive gold-standard?

2020 ◽  
Vol 13 (4) ◽  
pp. 184-190
Author(s):  
Muhammad Irfan ◽  
Abdul Rasheed Qureshi ◽  
Zeeshan Ashraf ◽  
Muhammad Amjad Ramzan ◽  
Tehmina Naeem ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Pleural Fluid ◽  
Gold Standard ◽  
Pleural Effusions ◽  
Diagnostic Efficacy ◽  
Chest Sonography ◽  
X Ray ◽  
Non Invasive ◽  
Fluid Detection

ABSTRACT Background: Conventionally Pleural effusions are suspected by history of pleuritis, evaluated by physical signs and multiple view radiography. Trans-thoracic pleural aspiration is done and aspirated pleural fluid is considered the gold-standard for pleural effusion. Chest sonography has the advantage of having high diagnostic efficacy over radiography for the detection of pleural effusion. Furthermore, ultrasonography is free from radiation hazards, inexpensive, readily available  and feasible for use in ICU, pregnant and pediatric patients. This study aims to explore the diagnostic accuracy of trans-thoracic ultrasonography for pleural fluid detection, which is free of such disadvantages. The objective is to determine the diagnostic efficacy of trans-thoracic ultrasound for detecting pleural effusion and also to assess its suitability for being a non-invasive gold-standard.   Subject and Methods: This retrospective study of 4597 cases was conducted at pulmonology  OPD-Gulab Devi Teaching Hospital, Lahore from November 2016 to July 2018. Adult patients with clinical features suggesting pleural effusions were included while those where no suspicion of pleural effusion, patients < 14 years and pregnant ladies were excluded. Patients were subjected to chest x-ray PA and Lateral views and chest ultrasonography was done by a senior qualified radiologist in OPD. Ultrasound-guided pleural aspiration was done in OPD & fluid was sent for analysis. At least 10ml aspirated fluid was considered as diagnostic for pleural effusion. Patient files containing history, physical examination, x-ray reports, ultrasound reports, pleural aspiration notes and informed consent were retrieved, reviewed and findings were recorded in the preformed proforma. Results were tabulated and conclusion was drawn by statistical analysis. Results: Out of 4597 cases, 4498 pleural effusion were manifested on CXR and only 2547(56.62%) pleural effusions were proved by ultrasound while 2050 (45.57%) cases were reported as no Pleural effusion. Chest sonography demonstrated sensitivity, specificity, PPV, NPV and diagnostic accuracy 100 % each. Conclusions: Trans-thoracic ultrasonography revealed an excellent efficacy that is why it can be considered as non-invasive gold standard for the detection of pleural effusion.

scholarly journals Acute myeloid leukemia with leukemic pleural effusion and high levels of pleural adenosine deaminase: A case report and review of literature

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 387-396
Author(s):  
Sing-Ting Wang ◽  
Chieh-Lung Chen ◽  
Shih-Hsin Liang ◽  
Shih-Peng Yeh ◽  
Wen-Chien Cheng
Keyword(s):  
Acute Myeloid Leukemia ◽  
Pleural Effusion ◽  
Adenosine Deaminase ◽  
Myeloid Leukemia ◽  
Diagnostic Yield ◽  
Leukemic Cells ◽  
Pleural Effusions ◽  
Diagnostic Dilemma ◽  
True Incidence ◽  
Acute Myeloid

Abstract Pleural effusions are rarely observed in association with acute myeloid leukemia (AML), and their true incidence remains unknown. Given the low diagnostic yield from cytopathologic analysis of malignant pleural effusions and the fact that patients with leukemia are often thrombocytopenic and unable to tolerate invasive procedures, the incidence of leukemic effusions may be underestimated. Here, we report a rare case of pleural effusion in a patient with newly diagnosed AML. Initial analysis revealed an exudative, lymphocyte-predominant effusion. High levels of adenosine deaminase (ADA) were detected in pleural fluid, consistent with a diagnosis of tuberculosis. However, the analysis of pleural cytology revealed leukemic cells, permitting the diagnosis of leukemic effusion to be made. The patient underwent induction chemotherapy and pleural effusion resolved without recurrence. This case emphasizes the diagnostic dilemma presented by high levels of ADA in a leukemic pleural effusion, as this association has not been previously considered in the literature.

scholarly journals The Differential Diagnostic Values of Cytokine Levels in Pleural Effusions

2005 ◽  
Vol 2005 (1) ◽  
pp. 2-8 ◽  
Author(s):  
Saadet Akarsu ◽  
A. Nese Citak Kurt ◽  
Yasar Dogan ◽  
Erdal Yilmaz ◽  
Ahmet Godekmerdan ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Parapneumonic Effusion ◽  
Pleural Effusions ◽  
Tuberculous Pleural Effusion ◽  
Cytokine Levels ◽  
Diagnostic Values

The aim is to examine whether the changes in pleural fluid interleukin (IL)-1β, IL-2, IL-6, and IL-8 levels were significant in differential diagnosis of childhood pleural effusions. IL-1β, IL-2, IL-6, and IL-8 levels in pleural fluids of all 36 patients were measured. The levels of IL-1β, IL-2, IL-6, and IL-8 in pleural fluids were statistically significantly higher in the transudate group compared with those of the exudate group. The levels of IL-1β, IL-6, and IL-8 were also found to be statistically significantly higher in the empyema group compared with both the parapneumonic and the tuberculous pleural effusion groups. The levels of IL-2 and IL-6 were detected to be statistically significantly higher in the tuberculous pleural effusion group in comparison with those of the parapneumonic effusion group. The results showed that pleural fluids IL-1β, IL-2, IL-6, and IL-8 could be used in pleural fluids exudate and transudate distinction.

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