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A Retrospective Study on the Diagnostic Yield of Medical Thoracoscopy in Diagnosis of Exudative Pleural Effusion
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A5008 - A Retrospective Study on the Diagnostic Yield of Medical Thoracoscopy in Diagnosis of Exudative Pleural Effusion
Author Block: S. Kho, M. Yong, S. Chan, S. Tie; Respiratory Medicine Unit, Department of Medicine, Sarawak General Hospital, Kuching, Malaysia.
Introduction
Medical thoracoscopy (MT) is gaining popularity among respiratory physicians because of its diagnostic and therapeutic role in managing exudative pleural effusion. MT allows direct visualization of the pleural cavity and biopsy of visually abnormal areas, which enhances the diagnostic yield. Overall diagnostic yield of MT was shown to be 71% in a 30 years experience analysis. It is a minimally invasive procedure which is relatively safe even in patients with high surgical risk. MT remains a very important tool for the diagnosis of exudative pleural effusion in regions where cytology service is under-developed by providing ample pleural biopsy specimen for histopathological examination.
Method
Retrospective chart review of all patients who underwent MT during the period between April 2016 to September 2017 in our center. All procedures were performed as in-patient using either semi-rigid (LTF-160, Olympus Medical, Japan) or rigid thoracoscope by chest physician.
Results
Our cohort comprised of 137 patients with 87 (63.5%) male and 50 (36.5%) female. Mean age was 57.8 ± 17.7 years old. MT was performed for suspected malignant pleural effusion in 67 (48.9%) cases, tuberculous pleural effusion in 36 (26.3%) cases and parapneumonic pleural effusion in 34 (24.8%) cases. Semi-rigid thoracoscope was used in 90 (65.7%) cases and rigid thoracoscope in 47 (34.3%) cases. Histological diagnosis was achieved in 130 (94.9%) cases with 58 (42.3%) malignancy, 56 (40.9%) tuberculosis and 16 (11.7%) parapneumonic cases. The remaining 7 cases (5.1%) remains inconclusive, which require further investigations. There was no difference in diagnostic yield comparing the usage of semi-rigid or rigid scope (95.6% vs. 93.6%, p=0.625). No procedural related mortality or major complications were encountered in our current cohort of patients.
Conclusion
MT is an effective and safe tool in the diagnosis of exudative pleural effusion. It reduces empirical therapy by providing histological evidence of disease, which improve patient’s care especially when initial non-invasive investigations were inconclusive.
Author Block: S. Kho, M. Yong, S. Chan, S. Tie; Respiratory Medicine Unit, Department of Medicine, Sarawak General Hospital, Kuching, Malaysia.
Introduction
Medical thoracoscopy (MT) is gaining popularity among respiratory physicians because of its diagnostic and therapeutic role in managing exudative pleural effusion. MT allows direct visualization of the pleural cavity and biopsy of visually abnormal areas, which enhances the diagnostic yield. Overall diagnostic yield of MT was shown to be 71% in a 30 years experience analysis. It is a minimally invasive procedure which is relatively safe even in patients with high surgical risk. MT remains a very important tool for the diagnosis of exudative pleural effusion in regions where cytology service is under-developed by providing ample pleural biopsy specimen for histopathological examination.
Method
Retrospective chart review of all patients who underwent MT during the period between April 2016 to September 2017 in our center. All procedures were performed as in-patient using either semi-rigid (LTF-160, Olympus Medical, Japan) or rigid thoracoscope by chest physician.
Results
Our cohort comprised of 137 patients with 87 (63.5%) male and 50 (36.5%) female. Mean age was 57.8 ± 17.7 years old. MT was performed for suspected malignant pleural effusion in 67 (48.9%) cases, tuberculous pleural effusion in 36 (26.3%) cases and parapneumonic pleural effusion in 34 (24.8%) cases. Semi-rigid thoracoscope was used in 90 (65.7%) cases and rigid thoracoscope in 47 (34.3%) cases. Histological diagnosis was achieved in 130 (94.9%) cases with 58 (42.3%) malignancy, 56 (40.9%) tuberculosis and 16 (11.7%) parapneumonic cases. The remaining 7 cases (5.1%) remains inconclusive, which require further investigations. There was no difference in diagnostic yield comparing the usage of semi-rigid or rigid scope (95.6% vs. 93.6%, p=0.625). No procedural related mortality or major complications were encountered in our current cohort of patients.
Conclusion
MT is an effective and safe tool in the diagnosis of exudative pleural effusion. It reduces empirical therapy by providing histological evidence of disease, which improve patient’s care especially when initial non-invasive investigations were inconclusive.
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