The diagnostic role of thoracoscope in undiagnosed pleural effusion: Rigid versus flexible

The role of medical thoracoscopy in the diagnosis of exudative lymphocytic pleural effusions: an observational study

Diagnosis of pleural effusion remains challenging despite extensive microbiological and radiological investigations. Pleural histopathological examination (HPE) is often needed to ascertain the etiology. Medical thoracoscopy (MT) is surpassing the other modalities of pleural biopsy on account of its high diagnostic yield. We aim to estimate the yield of MT in undiagnosed exudative lymphocytic pleural effusion and also intend to correlate gross thoracoscopy findings with HPE results. This retrospective observational study was conducted in a tertiary respiratory care center. Medical records of undiagnosed exudative lymphocytic predominant pleural effusion patients who underwent MT during the study period of 24 months were retrieved from the Medical Records Department. The clinico-demographic profile, radiological images, gross thoracoscopy findings, HPE reports, and post-procedure complications were recorded and analyzed using analysis of variance and chi-square test. The study comprised 62 patients with a mean age of 52 years at presentation. HPE of MT-guided biopsy confirmed tuberculosis in 22 (35.3%), malignancy in 18 (29%) cases, and 22 (35.5%) cases had chronic nonspecific inflammation. The most commonly observed MT finding in malignancy was pleural nodules (14.70%), followed by thickened pleura (10.50%) and growth (2.10%). In tuberculosis, the most common MT finding was adhesions in all, followed by nodules (5.28%). We also diagnosed a case of pleural amoebiasis and ependymoma, which are rare. Macroscopic findings had a significant correlation with the final histopathologic diagnosis, with a diagnostic yield of 66.1%. Gross thoracoscopic findings correlate well with the histopathological diagnosis of pleural effusion etiology, with a correlation coefficient of 0.73. Pleural nodules were the most common finding in malignancy, while adhesions were common in benign pathology like tuberculosis. A good diagnostic yield underscores the utility of MT in undiagnosed exudative lymphocytic pleural effusions.

Role of Single Port Rigid Thoracoscopy in Undiagnosed Pleural Effusion

BACKGROUND

In recent years, medical thoracoscopy has been well established to play an important role in undiagnosed pleural effusion; however, this procedure is underutilized due to limited availability of the instruments it requires. This study analysed the outcome of single port rigid thoracoscopy in patients with undiagnosed pleural effusions.

METHODS

This study retrospectively analysed the outcomes of all patients with undiagnosed pleural effusion presenting to our centre between 2016 to 2020 who underwent single port rigid medical thoracoscopy as a diagnostic procedure.

RESULTS

In total, 92 patients underwent single port rigid medical thoracoscopy. The most common presenting symptom was shortness of breath. A majority of the patients had lymphocytic exudative pleural effusion. The average biopsy sample size was 18 mm, and no major complication was reported in any of the patients.

CONCLUSION

Single port rigid thoracoscopy is a safe and well-tolerated procedure that yields a biopsy of a larger size with high diagnostic yield. Moreover, the low cost of the instruments required by this procedure makes it particularly suited for use in developing countries.

Comparing the diagnostic accuracy of semi-rigid and rigid pleuroscopy in diagnosis of exudative lymphocyte dominant pleural effusion with

BACKGROUND AND OBJECTIVES

Pleuroscopy is an appropriate technique for visualization and biopsy of the pleural lesions, performed by two different techniques. In this study, we aimed to investigate the diagnostic accuracy of semi-rigid and rigid pleuroscopy in patients with lymphocyte dominant exudative pleural effusion.

MATERIALS AND METHODS

In this study, patients with lymphocyte dominant pleural effusion with negative results for tuberculosis who referred to Imam Khomeini Hospital, Ahvaz, Iran; from 2018 to 2019 were selected by census method and randomized to undergo semi-rigid or rigid pleuroscopy (30 in each group). Patients' demographic, such as age and gender, were recorded and the pathologic results reported by the two pleuroscopy methods were compared and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were reported for each method. All statistical analyses were performed using SPSS v. 21.

RESULTS

Thirty patients were included in each group. The frequency of tuberculosis, malignancy, and other causes of pleural effusion had no difference between the two methods (P > 0.05). Semirigid pleuroscopy had a sensitivity of 81.5%, specificity of 66.6%, PPV of 75.6%, and NPV of 74%, while the relevant values in rigid pleuroscopy were 87.2%, 68.4%, 87.2%, and 68.4%, respectively.

CONCLUSION

These results, consistent with previous studies, indicated that both semi-rigid and semi-flexible pleuroscopy methods are accurate for diagnosis of lymphocyte dominant pleural effusion when performed by skilled specialists and other considerations, such as availability and costs, can be used for selection of each method.