Pleuroscopy in exudative pleural effusion: A North Malaysia experience

Background: Pleuroscopy is one of the investigation modalities available for further evaluation of exudative pleural effusion. Aims of this study is to determine the diagnostic yield and common cause for pleural effusion that underwent pleuroscopy in Respiratory department, Hospital Sultanah Bahiyah .Methods: This is a retrospective descriptive analysis study of 106 patient who underwent pleuroscopy in Hospital Sultanah Bahiyah between July 2014 till Dec 2016. Hospital Sultanah Bahiyah is the only centre doing this procedure in North Malaysia.Result: Biopsy were done in 91% of the cases with diagnostic yield of up to 97%. Most common finding were malignancy (55%) with adenocarcinoma being the commonest subtype. Second commonest finding are granulomatous inflammation (19%) which is not surprising given our burden of tuberculosis. Majority of our patient were male (58%) with mean age of 60 years old. With regard to safety only one case develop complication where the patient develops re-expansion pulmonary oedema with no procedure related mortality.Conclusion: Pleuroscopy is a very safe procedure. Despite the high Tuberculosis burden in Malaysia the most common cause for exudative pleural effusion were due to malignancy, hence pleuroscopy should be consider in all cases of exudative pleural effusion.

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

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20170014 ◽

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.

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Pleuroscopy early experience in the exudative pleural effusion of unknown etiology

Current Respiratory Medicine Reviews ◽

10.2174/2211556010666210728125810 ◽

2021 ◽

Vol 17 ◽

Author(s):

Atefeh Fakharian ◽

Hamidreza Jabbardarjani ◽

Mohamad Reza Masjedi ◽

Masoud Shamaei

Keyword(s):

Pleural Effusion ◽

Previous History ◽

Invasive Procedure ◽

Therapeutic Interventions ◽

Unknown Etiology ◽

Safe Procedure ◽

Pathologic Diagnosis ◽

Medical Thoracoscopy ◽

History Of ◽

Exudative Pleural Effusion

Background: Pleuroscopy (medical thoracoscopy) is a minimally invasive procedure to inspect and perform a biopsy of the pleural space as well as to perform therapeutic interventions; pleural fluid drainage and pleurodesis. Material and Methods: In a retrospective study in Kasra Hospital, Tehran-Iran, the patients with exudative pleural effusion of unknown etiology who underwent pleuroscopy, were evaluated. These patients had negative smear and culture for infective agents. Also, the cytological review was negative for malignancy. Results: 62 patients had undergone pleuroscopy, of which 29 (46.7) were men. After the final evaluation, 47 patients (75.8%) had a definite pathologic diagnosis, of which 39 (82.9%) were cancer. Through these 39 cases, 18 cases (46.1%) had a history of the previously confirmed cancer, in which pleural pathology was consistent with the initial diagnosis. In 21 cases (53.9%), metastatic cancers were detected without a previous history. From a total of 47 cases with definite pathologic diagnosis, 8 cases (17%) had histopathologic evidence of granulomatous lesions consistent with tuberculosis and 15 patients (24%) showed non-specific inflammatory lesions. There was no morbidity and mortality among these patients. Discussion: Considering that pleuroscopy is a safe procedure with high diagnostic accuracy, malignancy is the most finding in the exudative pleural effusion of unknown etiology. This increases the importance of this procedure in these cases to prevent wasting the time and smear-negative anti-TB treatment.

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Diagnostic Value of Flexible Thoracoscopy in Undiagnosed Cases of Exudative Pleural Effusion

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/571 ◽

2020 ◽

Vol 7 (47) ◽

pp. 2783-2786

Author(s):

Vengada Krishnaraj S.P. ◽

Gayathri S. Mohan ◽

Vinod Kumar V ◽

Sridhar R

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Complete Blood Count ◽

Diagnostic Yield ◽

Diagnostic Value ◽

Parietal Pleura ◽

Pleural Biopsy ◽

Cardiac Evaluation ◽

Exudative Pleural Effusion ◽

Fluid Cytology

BACKGROUND The diagnostic yield of thoracoscopy is 95 %, of pleural fluid cytology it is 62 % and of closed pleural biopsy is 44 %, in malignant effusion. We wanted to study the diagnostic utility of flexible thoracoscopy in undiagnosed exudative pleural effusion and compare the thoracoscopy findings with the histopathology results. METHODS The study was conducted in the Department of Respiratory Medicine, Government Stanley Medical College, Chennai, from January 2019 to January 2020. 40 patients were enrolled in this longitudinal observational study with moderate to massive effusion and were evaluated with pleural fluid aspiration and sent for cytology, protein sugar analysis, total count, and ADA. Those cases which are exudative pleural effusions, with ADA value of less than 40 IU / L were subjected to thoracoscopy after being evaluated for fitness for thoracoscopy with complete blood count, bleeding time, clotting time, sputum for AFB, ECG, pulse oximetry, cardiac evaluation and CT chest. RESULTS Thoracoscopy was done in 40 enrolled patients. In this study, biopsy was taken from the parietal pleura in all the cases. Of these 40 cases, 30 were male and 10 were female, that is 75 % males and 25 % females. The mean age of the study population was 43 ± 14.9. Patient with the lowest age in this study group was 18 years and highest was 71 years. 16 cases (40 %) presented with left sided pleural effusion. 24 cases (60 %) presented with right sided pleural effusion. 30 cases presented with massive effusion, and 10 cases with moderate effusion. Of the 40 cases, 27 cases presented with straw coloured pleural effusion. 13 cases were haemorrhagic effusion. Histopathologic examination showed 11 cases as malignant and 29 cases as non-malignant out of which 18 cases were of tuberculosis aetiology. Thoracoscopy revealed adhesions in 13 cases and mass lesion in 4 cases. Of the 4 mass lesions 3 came as malignant, normal pleura in 11 cases, 10 were non-malignant and 1 was malignant. Nodules were seen in 12 cases of which 7 came as malignant. Straw coloured effusion was seen in 27 cases, of which 2 were malignant. CONCLUSIONS The most important indication for thoracoscopy is exudative undiagnosed pleural effusion. The overall diagnostic yield in pleural fluid cytology is 62 % and blind pleural biopsy is 44 %. The diagnostic yield of thoracoscopy varies from 60 % to 97 % in various studies, whereas, in our study, it is 72.5 %. Visualization of the visceral and parietal pleura is another advantage, so that we can take biopsy from the abnormal areas. KEYWORDS Flexible Thoracoscopy, Undiagnosed Exudative Pleural Effusion

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

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2018.944 ◽

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.

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The diagnostic yield of closed needle pleural biopsy in exudative pleural effusion: a retrospective 10-year study

Annals of Translational Medicine ◽

10.21037/atm.2020.03.47 ◽

2020 ◽

Vol 8 (7) ◽

pp. 491-491

Author(s):

Tianli Zhang ◽

Bing Wan ◽

Li Wang ◽

Chuling Li ◽

Yangyang Xu ◽

...

Keyword(s):

Pleural Effusion ◽

Diagnostic Yield ◽

Pleural Biopsy ◽

Exudative Pleural Effusion

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

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/44095.13990 ◽

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.

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Evaluation of diagnostic value of n-terminal pro brain natriuretic peptide in pleural fluid with cardiac origin

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20180746 ◽

2018 ◽

Vol 5 (3) ◽

pp. 912

Author(s):

Behzad Babapour ◽

Mohammad Mirzaaghazadeh ◽

Bita Shahbazzadegan ◽

Hadi Mohsenifar ◽

Alireza Mohammadzadeh ◽

...

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Diagnostic Value ◽

Common Finding ◽

Shortness Of Breath ◽

Male And Female ◽

Significant Difference ◽

Long Time ◽

Very High ◽

Exudative Pleural Effusion

Background: Pleural effusion is a common finding in patients. For a long time, a light criterion is used to analysis of pleural effusion for separation of transudative from exudative fluid. Sensitivity of light criteria is very high to determine exudative pleural effusion (98%). However, the ability of these criteria for ruling out of transudative effusions is low. For this reason, this study was carried out to determine the level of NT-proBNP in pleural fluid.Methods: A descriptive-analytic study was carried out on 21 patients with complaints of shortness of breath and diagnosis of pleural effusion. Pleural fluid was tapped in these patients and the following tests were performed: LDH, total protein, albumin, cell count, cell differentiation, cytology for malignant cells, ADA, smear for AFB, gram smear and culture.The results of all experiments were analyzed using SPSS V16.Results: Mean age of participants was 65 years. Male and female frequencies were 52.4 and 47.6, respectively. 33.3% of patients had CHF, 28.5% TB, 19.4% malignancy, 4.76% hydatid, and the rest left without diagnosis. A pleural fluid in 66.7% of participants was exudative and in 33.3% was transudative. The levels of NT-proBNP (Pg/ml) in serum and pleural fluid of patients with CHF were 11288.42 and 11036.81, but in malignant patient were 1721.68 and 713.59, respectively, and the levels of NT-proBNP in serum and pleural fluid in TB patient were 2429.30 and 2810.08, respectively. Also, there was no significant difference between the levels of serum and pleural effusion NT-proBNP in transudative and exudative fluid but the level of NT-proBNP was significantly higher in CHF patients compared to others.Conclusions: The results showed that the levels of NT-proBNP in serum and pleural fluid of cardiac patients are higher than other patients, but no significant difference in NT-proBNP between transudative and exudative pleural effusion.

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Pleural biopsy in the diagnosis of lymphocytic exudative pleural effusion

Annals of King Edward Medical University ◽

10.21649/akemu.v11i4.1116 ◽

2016 ◽

Vol 11 (4) ◽

Author(s):

Javed Asghar Magsi ◽

Saulat Ullah Khan ◽

Shamshad Rasul Awan

Keyword(s):

Pleural Effusion ◽

Histopathological Examination ◽

Granulomatous Inflammation ◽

Clinical Problem ◽

Pleural Biopsy ◽

Medical College ◽

Fluid Analysis ◽

Common Diagnosis ◽

Common Causes ◽

Exudative Pleural Effusion

Pleural effusion is a common clinical problem in developed as well as developing countries. Tuberculosis and malignancy are common causes of exudative pleural effusion with lymphocytic predominance`. It is very difficult to diagnose the underlying cause by clinical, radiological or even pleural fluid analysis. These cases usually require pleural biopsy for definitive diagnosis2. Pleural biopsy is a safe ad reliable procedure ad is recomended to perform in all cases of exudative pleural effusion. Objective of this study was to list the frequency of patients with lymphocytic exudative pleural effusion diagnosed on pleural biopsy. This study was conducted at the Institute of Chest Medicine Mayo Hospital Lahore. A total of 50 patients, who fulfilled the criteria, were included in this study and underwent closed pleural biopsy. These were then investigated by histopathology. Histopathological examination of pleural biopsy was performed by department of pathology King Edwerd Medical College Lahore. A total of 5 0 patients underwent; closed pleural biopsy. Adequate pleural tissue was obtained in 30 patients (60% of cases) the most common diagnosis made was granulomatous inflammation most likely tuberculosis. Histopathological evaluation of pleural biopsy specimens can lead to diagnosis in 46% of patients with exudative lymphocytic pleural effusion.

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Medical thoracoscopy in evaluation of undiagnosed pleural effusion

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191680 ◽

2019 ◽

Vol 7 (5) ◽

pp. 1803

Author(s):

Khurshid Ahmad Dar ◽

Sheikh Tariq Sultan ◽

Ahmed Jamal Jamil ◽

Nazia Mehfooz ◽

Naveed Nazir Shah ◽

...

Keyword(s):

Pleural Effusion ◽

Diagnostic Yield ◽

Cost Effective ◽

Histopathological Diagnosis ◽

Complication Rates ◽

Safe Procedure ◽

Diagnostic Modality ◽

Medical Thoracoscopy ◽

Multiple Variable ◽

Age Range

Background: Medical thoracoscopy or pleuroscopy, in recent past has received lot of interest for diagnostic as well as therapeutic purposes. In the evaluation of undiagnosed pleural effusion, it has become a key diagnostic modality as it is a cost effective and safe procedure. The aim of present study was to assess the diagnostic yield of medical thoracoscopy in patients with undiagnosed exudative pleural effusion.Methods: This prospective study was conducted at government chest diseases hospital Srinagar between December 2016 to June 2018. One hundred and twenty-five (125) patients who fulfilled inclusion criteria were included in this study. Thoracoscopy was done using rigid thoracoscope under local anesthesia. Thoracoscopic and histopathological data of enrolled patients was collected prospectively and analysed.Results: Patients enrolled in the study were in the age range of 17 to 82 years and consisted of 80 males and 45 females. Most common thoracoscopic finding was multiple variable sized nodules (53.6%) followed by sago grain infiltration (15.2%). Malignancy was the most common histopathological diagnosis (60.8%) with metastatic adenocarcinoma being the most common histopathological diagnosis (50%). The overall diagnostic yield of thoracoscopy was 90.4%.Conclusions: Medical thoracoscopy is a safe procedure with excellent diagnostic yield for evaluation of undiagnosed pleural effusion with minimal complication rates.

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