Diagnostic Value and Safety of Medical Thoracoscopy in the Management 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 and safety of medical thoracoscopy in tuberculous pleural effusion

Respiratory Medicine ◽

10.1016/j.rmed.2015.06.008 ◽

2015 ◽

Vol 109 (9) ◽

pp. 1188-1192 ◽

Cited By ~ 26

Author(s):

Zhen Wang ◽

Li-Li Xu ◽

Yan-Bing Wu ◽

Xiao-Juan Wang ◽

Yuan Yang ◽

...

Keyword(s):

Pleural Effusion ◽

Diagnostic Value ◽

Tuberculous Pleural Effusion ◽

Medical Thoracoscopy

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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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Medical Thoracoscopy for the Management of Exudative Pleural Effusion: A Retrospective Study

Risk Management and Healthcare Policy ◽

10.2147/rmhp.s287758 ◽

2020 ◽

Vol Volume 13 ◽

pp. 2845-2855

Author(s):

Ling Gong ◽

Guichuan Huang ◽

Yi Huang ◽

Daishun Liu ◽

Xiaoping Tang

Keyword(s):

Retrospective Study ◽

Pleural Effusion ◽

Medical Thoracoscopy ◽

Exudative Pleural Effusion

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Role of Medical Thoracoscopy Guided Pleural Biopsy in Diagnosis of Moderate to Massive Exudative Pleural Effusion

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v5i7.131 ◽

2017 ◽

Vol 5 (7) ◽

Author(s):

Adesh Kumar ◽

Keyword(s):

Pleural Effusion ◽

Pleural Biopsy ◽

Medical Thoracoscopy ◽

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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