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Utility of semi-rigid thoracoscopy in undiagnosed exudative pleural effusion.

Nattusamy L, Madan K, Mohan A, Hadda V, Jain D, Madan NK, Arava S, Khilnani GC, Guleria R - Lung India (2015 Mar-Apr)

Bottom Line: Overall, a definitive diagnosis of either pleural malignancy or TB was obtained in 32 (66.7%) patients.Combined overall sensitivity, specificity, positive predictive value and negative predictive value of thoracoscopic pleural biopsy for malignant pleural effusion were 96.77%, 100%, 100% and 66.67%, respectively.There was no procedure-related mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT

Background: Semi-rigid thoracoscopy is a safe and efficacious procedure in patients with undiagnosed pleural effusion. Literature on its utility from developing countries is limited. We herein describe our initial experience on the utility of semi-rigid thoracoscopy from a tertiary care teaching and referral center in north India. We also perform a systematic review of studies reporting the utility of semi-rigid thoracoscopy from India.

Patients and methods: The primary objective was to evaluate the diagnostic utility of semi-rigid thoracoscopy in patients with undiagnosed exudative pleural effusion. Semi-rigid thoracoscopy was performed under local anesthesia and conscious sedation in the bronchoscopy suite.

Results: A total of 48 patients underwent semi-rigid thoracoscopy between August 2012 and December 2013 for undiagnosed pleural effusion. Mean age was 50.9 ± 14.1 years (range: 17-78 years). Pre-procedure clinico-radiological diagnoses were malignant pleural effusion [36 patients (75%)], tuberculosis (TB) [10 (20.83%) patients], and empyema [2 patients (4.17%)]. Patients with empyema underwent the procedure for pleural biopsy, optimal placement of intercostal tube and adhesiolysis. Thoracoscopic pleural biopsy diagnosed pleural malignancy in 30 (62.5%) patients and TB in 2 (4.17%) patients. Fourteen (29.17%) patients were diagnosed with non-specific pleuritis and normal pleura was diagnosed on a pleural biopsy in 2 (4.17%) patients. Overall, a definitive diagnosis of either pleural malignancy or TB was obtained in 32 (66.7%) patients. Combined overall sensitivity, specificity, positive predictive value and negative predictive value of thoracoscopic pleural biopsy for malignant pleural effusion were 96.77%, 100%, 100% and 66.67%, respectively. There was no procedure-related mortality. On performing a systematic review of literature, four studies on semi-rigid thoracoscopy from India were identified.

Conclusion: Semi-rigid thoracoscopy is a safe and efficacious procedure in patients with undiagnosed exudative pleural effusions.

No MeSH data available.


Related in: MedlinePlus

Left panel - CECT examination of the thorax in a patient with rheumatoid arthritis demonstrating a large loculated right pleural effusion. Right panel: Thoracoscopic appearance of a large area of plaque like erythema over the visualized parietal pleura from which pleural biopsy is being obtained. Histopathological examination of pleural biosy demonstrated non specific chronic inflammation
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Figure 3: Left panel - CECT examination of the thorax in a patient with rheumatoid arthritis demonstrating a large loculated right pleural effusion. Right panel: Thoracoscopic appearance of a large area of plaque like erythema over the visualized parietal pleura from which pleural biopsy is being obtained. Histopathological examination of pleural biosy demonstrated non specific chronic inflammation

Mentions: Sixteen (33.33%) patients remained undiagnosed after thoracoscopic pleural biopsy [pathological findings of non-specific pleuritis (14) or normal pleura (2)]. Among 14 patients with non-specific pleuritis, 5 patients were started on anti-tuberculosis therapy (ATT) based on a clinical possibility of underlying TB. Two patients had complete response (resolution of effusion) with ATT, one patient is currently on ATT (under follow-up and showing improvement) and one patient was lost follow-up. The remaining fifth patient, who was initially started on ATT, was later diagnosed to have adenocarcinoma lung on follow-up. Six patients expired on follow-up in the non-specific pleuritis group. The remaining three patients with non-specific pleuritis were lost to follow-up. Pleural biopsy samples were sent for mycobacterial cultures in 19 (40.43%) patients and all were negative. The representative appearances of non-specific pleuritis and TB are shown in Figures 2 and 3, respectively.


Utility of semi-rigid thoracoscopy in undiagnosed exudative pleural effusion.

Nattusamy L, Madan K, Mohan A, Hadda V, Jain D, Madan NK, Arava S, Khilnani GC, Guleria R - Lung India (2015 Mar-Apr)

Left panel - CECT examination of the thorax in a patient with rheumatoid arthritis demonstrating a large loculated right pleural effusion. Right panel: Thoracoscopic appearance of a large area of plaque like erythema over the visualized parietal pleura from which pleural biopsy is being obtained. Histopathological examination of pleural biosy demonstrated non specific chronic inflammation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372864&req=5

Figure 3: Left panel - CECT examination of the thorax in a patient with rheumatoid arthritis demonstrating a large loculated right pleural effusion. Right panel: Thoracoscopic appearance of a large area of plaque like erythema over the visualized parietal pleura from which pleural biopsy is being obtained. Histopathological examination of pleural biosy demonstrated non specific chronic inflammation
Mentions: Sixteen (33.33%) patients remained undiagnosed after thoracoscopic pleural biopsy [pathological findings of non-specific pleuritis (14) or normal pleura (2)]. Among 14 patients with non-specific pleuritis, 5 patients were started on anti-tuberculosis therapy (ATT) based on a clinical possibility of underlying TB. Two patients had complete response (resolution of effusion) with ATT, one patient is currently on ATT (under follow-up and showing improvement) and one patient was lost follow-up. The remaining fifth patient, who was initially started on ATT, was later diagnosed to have adenocarcinoma lung on follow-up. Six patients expired on follow-up in the non-specific pleuritis group. The remaining three patients with non-specific pleuritis were lost to follow-up. Pleural biopsy samples were sent for mycobacterial cultures in 19 (40.43%) patients and all were negative. The representative appearances of non-specific pleuritis and TB are shown in Figures 2 and 3, respectively.

Bottom Line: Overall, a definitive diagnosis of either pleural malignancy or TB was obtained in 32 (66.7%) patients.Combined overall sensitivity, specificity, positive predictive value and negative predictive value of thoracoscopic pleural biopsy for malignant pleural effusion were 96.77%, 100%, 100% and 66.67%, respectively.There was no procedure-related mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT

Background: Semi-rigid thoracoscopy is a safe and efficacious procedure in patients with undiagnosed pleural effusion. Literature on its utility from developing countries is limited. We herein describe our initial experience on the utility of semi-rigid thoracoscopy from a tertiary care teaching and referral center in north India. We also perform a systematic review of studies reporting the utility of semi-rigid thoracoscopy from India.

Patients and methods: The primary objective was to evaluate the diagnostic utility of semi-rigid thoracoscopy in patients with undiagnosed exudative pleural effusion. Semi-rigid thoracoscopy was performed under local anesthesia and conscious sedation in the bronchoscopy suite.

Results: A total of 48 patients underwent semi-rigid thoracoscopy between August 2012 and December 2013 for undiagnosed pleural effusion. Mean age was 50.9 ± 14.1 years (range: 17-78 years). Pre-procedure clinico-radiological diagnoses were malignant pleural effusion [36 patients (75%)], tuberculosis (TB) [10 (20.83%) patients], and empyema [2 patients (4.17%)]. Patients with empyema underwent the procedure for pleural biopsy, optimal placement of intercostal tube and adhesiolysis. Thoracoscopic pleural biopsy diagnosed pleural malignancy in 30 (62.5%) patients and TB in 2 (4.17%) patients. Fourteen (29.17%) patients were diagnosed with non-specific pleuritis and normal pleura was diagnosed on a pleural biopsy in 2 (4.17%) patients. Overall, a definitive diagnosis of either pleural malignancy or TB was obtained in 32 (66.7%) patients. Combined overall sensitivity, specificity, positive predictive value and negative predictive value of thoracoscopic pleural biopsy for malignant pleural effusion were 96.77%, 100%, 100% and 66.67%, respectively. There was no procedure-related mortality. On performing a systematic review of literature, four studies on semi-rigid thoracoscopy from India were identified.

Conclusion: Semi-rigid thoracoscopy is a safe and efficacious procedure in patients with undiagnosed exudative pleural effusions.

No MeSH data available.


Related in: MedlinePlus