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Pleuroscopy with Parietal Pleural Biopsy Followed by Tunneled Pleural Catheter: An Effective Diagnostic and Therapeutic Approach for Recurrent Pleural Effusion
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A4224 - Pleuroscopy with Parietal Pleural Biopsy Followed by Tunneled Pleural Catheter: An Effective Diagnostic and Therapeutic Approach for Recurrent Pleural Effusion
Author Block: J. Chang, D. Teodoro, V. Murthy, S. Rafeq, J. L. Bessich, G. C. Michaud; NYU Langone Health, New York, NY, United States.
RATIONALE Pleuroscopy is a safe, minimally invasive diagnostic and therapeutic tool for both malignant and benign pleural disease. Recent studies suggest that it can be performed outpatient, and pleuroscopy can be combined with talc pleurodesis followed by tunneled pleural catheter (TPC) placement to reduce length of stay and cost in malignant effusions. We hypothesized that outpatient pleuroscopy with parietal pleural biopsy followed by TPC placement was safe and effective means to achieve pleurodesis and determine the etiology of the effusion.
METHODS The study included 57 consecutive patients undergoing pleuroscopy for diagnosis and management of recurrent, symptomatic pleural effusion. Multiple parietal pleural biopsies were taken for pathology and/or culture using rigid thoracoscope and optical biopsy forceps. TPC was tunneled and advanced into pleural space upon completion of biopsies. Incision was closed, and then catheter was secured with -20cm H2O suction for approximately 1 hour. When post-procedure chest x-ray confirmed lung re-expansion, patient was discharged. Patients were drained 500-1000ml three times weekly until 2-week follow-up visit and then every 8 weeks or until “pleurodesis.” Outcomes measures documented at each visit included symptom management, catheter output, complication rates, need for re-intervention, and related healthcare costs.
RESULTS A total of 57 pleuroscopies with parietal pleural biopsies and TPC placement were performed over a 22 month period. Of the procedures, 18 resulted in a benign diagnosis versus 39 for malignancy. 79% of patients were discharged on the day of the procedure with mean length of stay of 6.5 hours. 91% of patients had resolution of their symptoms at the 2-week visit. Median time to catheter removal was 35 days (range 6 to 198) for all patients. 86% of patients had successful pleurodesis without further interventions. No significant complications occurred.
CONCLUSIONS Pleuroscopy with parietal pleural biopsies followed by tunneled pleural catheter placement is a safe and effective means of both obtaining diagnostic material and palliation of dyspnea in malignant and benign pleural disease. In addition, the combined procedure results in a high pleurodesis rate without the potential toxicities associated with intrapleural instillation of pleurodesis agents.
Author Block: J. Chang, D. Teodoro, V. Murthy, S. Rafeq, J. L. Bessich, G. C. Michaud; NYU Langone Health, New York, NY, United States.
RATIONALE Pleuroscopy is a safe, minimally invasive diagnostic and therapeutic tool for both malignant and benign pleural disease. Recent studies suggest that it can be performed outpatient, and pleuroscopy can be combined with talc pleurodesis followed by tunneled pleural catheter (TPC) placement to reduce length of stay and cost in malignant effusions. We hypothesized that outpatient pleuroscopy with parietal pleural biopsy followed by TPC placement was safe and effective means to achieve pleurodesis and determine the etiology of the effusion.
METHODS The study included 57 consecutive patients undergoing pleuroscopy for diagnosis and management of recurrent, symptomatic pleural effusion. Multiple parietal pleural biopsies were taken for pathology and/or culture using rigid thoracoscope and optical biopsy forceps. TPC was tunneled and advanced into pleural space upon completion of biopsies. Incision was closed, and then catheter was secured with -20cm H2O suction for approximately 1 hour. When post-procedure chest x-ray confirmed lung re-expansion, patient was discharged. Patients were drained 500-1000ml three times weekly until 2-week follow-up visit and then every 8 weeks or until “pleurodesis.” Outcomes measures documented at each visit included symptom management, catheter output, complication rates, need for re-intervention, and related healthcare costs.
RESULTS A total of 57 pleuroscopies with parietal pleural biopsies and TPC placement were performed over a 22 month period. Of the procedures, 18 resulted in a benign diagnosis versus 39 for malignancy. 79% of patients were discharged on the day of the procedure with mean length of stay of 6.5 hours. 91% of patients had resolution of their symptoms at the 2-week visit. Median time to catheter removal was 35 days (range 6 to 198) for all patients. 86% of patients had successful pleurodesis without further interventions. No significant complications occurred.
CONCLUSIONS Pleuroscopy with parietal pleural biopsies followed by tunneled pleural catheter placement is a safe and effective means of both obtaining diagnostic material and palliation of dyspnea in malignant and benign pleural disease. In addition, the combined procedure results in a high pleurodesis rate without the potential toxicities associated with intrapleural instillation of pleurodesis agents.
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