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A5563 - Benefit of Medical Thoracoscopy for the Diagnosis of Tuberculous Pleuritis
Author Block: M. Shimada1, M. Ohgiya2, J. Suzuki3, K. Masuda3, H. Matsui2, K. Ohta3; 1Respiratory medicine, Tokyo National Hospital, Tokyo, Japan, 2Center for Pulmonary Diseases, Tokyo National Hospital, tokyo, Japan, 3Tokyo National Hospital, tokyo, Japan.
Background: The detection of Mycobacterium tuberculosis is the basic principle for the diagnosis of tuberculosis (TB). Since isolation of the bacilli from pleural effusion is often difficult, the diagnosis of tuberculous pleuritis is clinically made with high ADA value of the effusion and positive interferon gamma release assay (IGRA) of blood tests. After introduced, medical thoracoscopy was performed in many hospitals in the early stages of diagnostic process of pleural effusion. Increasing number of reports demonstrated the benefit of medical thoracoscopy for the detection of M. tuberculosis. Purpose: To elucidate the clinical features of recent cases of tuberculous pleuritis diagnosed by medical thoracoscopy. Methods: Medical thoracoscopy was performed in 253 cases between Jan 2012 - Sep 2015 in our institution. Medical records were retrospectively reviewed in 56 patients with tuberculous pleuritis, for whom medical thoracoscopy was performed; for the diagnosis of pleural effusion in 52 cases and after the diagnosis in 4 cases. Clinical information, findings of medical thoracoscopy, microbiological examination, and pathological findings were extracted from the chart. Results: The patients included in this study were 37 males and 19 females with right (38/56) or left (18/56) pleural effusion. The mean ADA value of pleural effusion was 94.1 U/L (range 24.5-145.5) and IGRA of blood revealed positive in 41, borderline in 5, negative in 2, and indeterminant in 1. TB-TRC of the pleural effusion was positive in 20% (10/50) and the TB culture of the effusion was positive in 54.5% of cases (30/55). As for the tissue specimens, TB-TRC was positive in 54.3% (19/35) and culture was positive in 76.5% (39/51). Pathological examination found granulomas in 83.6%. In 10 cases, the bacilli were confirmed only from the specimens obtained by thoracoscopy. The overall positive rate of TB diagnosis by medical thoracoscopy was 90.4% (47/52) with either TB-TRC, culture, or granuloma detection by histology. Medical thoracoscopy was performed without any adverse effects, with mean duration of 41.0 min and 714 ml of drained fluid. We added 500-1000ml of saline into the pleural space to safely perform the thoracoscopy in 8 cases of small amount of pleural effusion. Conclusions: Medical thoracoscopy is a safe procedure and superior to thoracentesis for the diagnosis of tuberculous pleural effusion. Medical thoracoscopy should be used in cases suspected of tuberculous pleuritis.