Background In patients with pleural effusion, even after extensive diagnostic evaluation, the aetiology often remains unclear. The diagnostic yield from simple pleural fluid aspiration and blind pleural biopsy is very limited. Medical thoracoscopy can be performed under controlled sedation and enables direct visualisation of the pleural surfaces to obtain targeted sampling, to improve the diagnostic yield.1
Aim To review local practise and experience of medical thoracoscopy.
Methods Retrospective analysis of 112 cases over a period of four years was performed to look at the diagnostic yield. We compared simple pleural aspiration with thoracoscopy and examined the relationship between the computed tomography (CT) appearances and histology results.
Results Of the 112 cases, 83 (74%) were male and 27 (26%) female. The age range was 32 to 90 years (mean – 69). No major adverse events were reported following the procedure. Two patients had the procedure performed twice due to recurrence. One sample was lost. The results for the remaining 111 patients are presented in the table.
Of the 69 patients who were diagnosed with malignancy, pleural fluid aspiration was positive in only 29 (43%) cases. CT evidence of pleural thickening was noted in only 28 (41%) of these cases, all of which turned to be malignant.
Our study reiterates the fact that medical thoracoscopy has a better diagnostic yield than simple pleural aspiration and is a safe procedure that can be performed safely by chest physicians in a DGH setting.
In our case series the presence of pleural thickening on CT was a strong predictor of malignancy. However the majority of malignant cases had no evidence of pleural thickening.
BTS pleural disease guideline - 2010.