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Experience in medical thoracoscopy: a 4-year retrospective study

Abstract

Objective

The aim was to document our experience in rigid medical thoracoscopy in the diagnosis of pleural effusion of undetermined origin in a 4-year retrospective study regarding its safety, complications, and diagnostic yield.

Patients and methods

Data of 134 patients who underwent medical thoracoscopy in Alexandria Main University Hospital, Chest Department, for diagnosing pleural effusion of undetermined origin were reviewed to assess the diagnostic yield, safety, and complications of rigid medical thoracoscopy.

Results

We reviewed records of 134 patients [62 (46%) males and 72 (54%) females]. Their mean age was 54±13.43 years. On combining histopathological and bacteriological examination results of thoracoscopic pleural biopsies, all patients were finally diagnosed, except for 13 (10%) patients who remained idiopathic; 97 (72%) patients were diagnosed as having malignant pleural effusion and 24 (18%) patients were diagnosed as having benign pleural effusion. The commonest complication encountered was postprocedural pain (35%), followed by subcutaneous emphysema (19%). Overall, the procedure was safe even in elderly patients. No procedure-related mortality was reported.

Conclusion

Medical thoracoscopy, in our experience, is a safe and well-tolerated procedure even in elderly patients with high diagnostic yield.

References

  1. Poe RH, Israel RH, Utell MJ, Hall WJ, Greenblatt DW, Kallay MC. Sensitivity, specificity, and predictive values of closed pleural biopsy. Arch Intern Med 1984; 144: 325–328.

    Article  CAS  Google Scholar 

  2. Prakash UB, Reiman HM. Comparison of needle biopsy with cytologic analysis for the evaluation of pleural effusion: analysis of 414 cases. Mayo Clin Proc 1985; 60: 158–164.

    Article  CAS  Google Scholar 

  3. Hassanein E, Hatata E, Helal S, Ibrahim E, Baess A. Rigid medical thoracoscopy in management of exudative pleural effusion. Chest 2014 ? 145: 289A.

  4. Shoukri A. Medical thoracoscopy: past, present, and future. Egypt J Bronchol 2013; 7: 50–52.

    Article  Google Scholar 

  5. Light RW, McGregor MI, Luchsinger PC, Ball WC. Pleural effusions: the diagnostic separation of transudates from exudates. Ann Inter Med 1972; 77: 507–513.

    Article  CAS  Google Scholar 

  6. Sahn SA, Heffner JE. Pleural fluid analysis. In: Light RW, Lee YCG, editors. Textbook of pleural diseases. UK: Hodder A; 2008. 209–226.

  7. Boutin C, Viallat JR, Cargnino P, Farisse P. Thoracoscopy in malignant pleural effusions. Am Rev Respir Dis 1981; 124: 588–592.

    CAS  PubMed  Google Scholar 

  8. Hooper C, Gary Lee YC, Maskell N. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65(Suppl 2): ii4–ii17.

    PubMed  Google Scholar 

  9. Lee YC, Knox BS, Garrett JE. Use of cytokeratin fragments 19.1 and 19.21 (Cyfra 21-1) in the differentiation of malignant and benign pleural effusions. Aust N Z J Med 1999; 29: 765–769.

    Article  CAS  Google Scholar 

  10. Janssen JP, Thunnissen FBJM, Visser FJ. Comparison of the 2.0 mm and 3.5 mm minithoracoscopy set to standard equipment for medical thoracoscopy. Eur Respir J 2003; 22: S541.

  11. Tomlinson JR. Invasive procedures in the diagnosis of pleural disease. Semin Respir Med 1987; 9: 31–36.

    Article  Google Scholar 

  12. Cantó A, Ferrer G, Romagosa V, Moya J, Bernat R. Lung cancer and pleural effusion. Clinical significance and study of pleural metastatic locations. Chest 1985; 87: 649–652.

    Article  Google Scholar 

  13. American Thoracic Society. Management of malignant pleural effusions. Am J Respir Crit Care Med 2000; 162: 1987–2001.

    Article  Google Scholar 

  14. Ng TH, How SH, Kuan YC, Hasmah H, Norra H, Fauzi AR. Medical thoracoscopy: Pahang experience. Med J Malaysia 2008; 63: 298–301.

    CAS  PubMed  Google Scholar 

  15. Kendall SW, Bryan AJ, Large SR, Wells FC. Pleural effusions: is thoracoscopy a reliable investigation? A retrospective review. Respir Med 1992; 86: 437–440.

    Article  CAS  Google Scholar 

  16. Rami-Porta R, Crowley JJ, Goldstraw P. The revised TNM staging system for lung cancer. Ann Thorac Cardiovasc Surg 2009; 15: 4–9.

    PubMed  Google Scholar 

  17. Khaleeq G, Musani AI. Emerging paradigms in the management of malignant pleural effusions. Respir Med 2008; 102: 939–948.

    Article  Google Scholar 

  18. Mootha VK, Agarwal R, Singh N, Aggarwal AN, Gupta D, Jindal SK. Medical thoracoscopy for undiagnosed pleural effusions: experience from a tertiary care hospital in north India. Indian J Chest Dis Allied Sci 2011; 53: 21–24.

    CAS  PubMed  Google Scholar 

  19. Enk B, Viskum K. Diagnostic thoracoscopy. Eur J Respir Dis 1981; 62: 344–351.

    CAS  PubMed  Google Scholar 

  20. Loddenkemper R. Thoracoscopy: results in non cancerous and idiopathic pleural effusions. Poumon Coeur 1981; 37: 261–264.

    CAS  PubMed  Google Scholar 

  21. Boutin C, Cargnino P, Viallat JR. Thoracoscopy in the early diagnosis of malignant pleural effusions. Endoscopy 1980; 12: 155–160.

    Article  CAS  Google Scholar 

  22. Venekamp LN, Velkeniers B, Noppen M. Does ‘idiopathic pleuritis’ exist? Natural history of non-specific pleuritis diagnosed after thoracoscopy. Respiration 2005; 72: 74–78.

    Article  CAS  Google Scholar 

  23. Janssen J, Ramlal S, Mravunac M. The long-term follow up of exudative pleural effusion after nondiagnostic thoracoscopy. J Bronchol 2004; 11: 169–174.

    Article  Google Scholar 

  24. Ryan CJ, Rodgers RF, Unni KK. The outcome of patients with pleural effusion of indeterminate cause at thoracotomy. Mayo Clin Proc 1981; 56: 145–149.

    CAS  PubMed  Google Scholar 

  25. Schonfeld N, Schwarz C, Kollmeier J, Blum T, Bauer TT, Ott S. Narrow band imaging (NBI) during medical thoracoscopy: first impressions. J Occup Med Toxicol 2009; 4: 24–29.

    Article  Google Scholar 

  26. Menzies R, Charbonneau M. Thoracoscopy for the diagnosis of pleural disease. Ann Intern Med 1991; 114: 271–276.

    Article  CAS  Google Scholar 

  27. De Campos JR, Vargas FS, de Campos Werebe E, Cardoso P, Teixeira LR, Jatene FB, Light RW. Thoracoscopy talc poudrage: a 15-year experience. Chest 2001; 119: 801–806.

    Article  Google Scholar 

  28. Douketis DJD. BRIDGE Study, Duke Clinical Re search Institute, Durham, NCSt. Ontario, Canada: Joseph’s Healthcare Hamilton, Ontario, Canada Circulation, 2012.

  29. Migliore M, Giuliano R, Aziz T, Saad RA, Sgalambro F. Four-step local anesthesia and sedation for thoracoscopic diagnosis and management of pleural diseases. Chest 2002; 121: 2032–2035.

    Article  Google Scholar 

  30. Sakuraba M, Masuda K, Hebisawa A, Sagara Y, Komatsu H. Diagnostic value of thoracoscopic pleural biopsy for pleurisy under local anaesthesia. ANZ J Surg 2006; 76: 722–724.

    Article  Google Scholar 

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Correspondence to Ayman I. Baess MD, PhD.

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Baess, A.I., Sweed, R.A. Experience in medical thoracoscopy: a 4-year retrospective study. Egypt J Bronchol 13, 73–80 (2019). https://doi.org/10.4103/ejb.ejb_50_18

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