Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions in Denmark

Our plain-English summary of Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions in Denmark, by F. Willendrup, U. Bodtger, S. Colella, et al (Journal of Bronchology & Interventional Pulmonology, 2014).

The study

• Authors: F. Willendrup, U. Bodtger, S. Colella, D. Rasmussen, P.F. Clementsen
• Journal: Journal of Bronchology & Interventional Pulmonology
• Published: 2014;21(3):215-9
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: To assess the diagnostic accuracy and the safety of medical thoracoscopy (MT) performed with the semirigid thoracoscope.

Methods: We retrospectively evaluated patients who underwent MT with semirigid thoracoscope under local anesthesia for unexplained exudative pleural effusion from March 1, 2009 to September 1, 2013 in Denmark.

Results: Sixty-nine patients were retrospectively studied. In 13 patients it was not possible to perform the scheduled MT, in 9 cases due to an insufficient pneumothorax, in 3 due to an insufficient pleural effusion, and in 1 due to a purulent pleuritis. In 56 patients in whom MT was completed, the procedure was diagnostic in 44 cases: malignancy was reported in 26 patients and a benign diagnosis in 18. In the remaining 12 patients a definite diagnosis was not reached, and further testing was required.In an "intention-to-treat analysis" (69 patients in total), the diagnostic accuracy of MT was 63%, the sensitivity for malignancy was 59% [95% confidence interval (CI)=43%-73%], the specificity was 100% (95% CI=86%-100%), and the negative likelihood ratio was 0.41 (95% CI=0.29-0.58). Considering the 56 patients in whom it was possible to complete the procedure, the diagnostic accuracy was 78%, the sensitivity for malignancy was 74% (95% CI=54%-87%), the specificity was 100% (95% CI=83.75%-100%), and the negative likelihood ratio was 0.27 (95% CI=0.15%-0.45%). No mortality was reported.

Conclusions: MT performed under local anesthesia with a semirigid scope is a simple and safe procedure with an acceptable sensitivity for malignancy.

In plain English

This retrospective study reviewed 69 patients with unexplained exudative pleural effusion scheduled for medical thoracoscopy with a semirigid scope under local anesthesia. They were treated at Denmark's only two departments doing the procedure, March 2009 to September 2013. Of the 69, 26 (37%) were listed as asbestos exposed; exposure was not analyzed further. The procedure could not be performed in 13 patients, in 9 because a sufficient pneumothorax could not be achieved. In the 56 completed procedures, a diagnosis was reached in 44 (78%): malignancy in 26, including 16 mesothelioma, and a benign diagnosis in 18. Counting all 69 patients, diagnostic accuracy was 63% and sensitivity for malignancy 59% (95% CI 43%-73%). Among the 56 completed procedures, sensitivity was 74% (95% CI 54%-87%). Specificity was 100% in both analyses (95% CI 86%-100% for all 69; 83.75%-100% for the 56). Two patients had a prolonged air leak needing an additional chest tube. No deaths due to the procedure were reported. The authors concluded the procedure is simple and safe with acceptable sensitivity for malignancy. They named the retrospective design as a limitation.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: retrospective observational study of diagnostic accuracy and safety
• Who was studied: 69 patients with unexplained exudative pleural effusion and an indication for medical thoracoscopy, admitted to two Danish departments (Naestved Hospital and Gentofte University Hospital) from March 1, 2009 to September 1, 2013; median age 70 (range 46-85), male to female ratio 4.75
• Exposure: The procedure studied was medical thoracoscopy with a semirigid thoracoscope (Olympus LTF 160) under local anesthesia. Table 1 records 26 patients (37%) as asbestos exposed. No fiber types or exposure details are given, and exposure was not analyzed.
• Main results:
  • In 13 of 69 patients the scheduled procedure could not be performed: in 9 a sufficient pneumothorax could not be achieved, in 3 there was not enough pleural effusion, and in 1 a purulent pleuritis was found.
  • Of the 13 patients whose procedure was not performed, 9 were later diagnosed with malignant disease (6 mesothelioma, 3 carcinoma metastases) by other procedures.
  • Among the 56 patients with a completed procedure, it was diagnostic in 44 (diagnostic accuracy 78%).
  • Among the 44 diagnostic procedures, malignancy was reported in 26 patients (16 mesothelioma, 9 carcinoma metastases, 1 chronic lymphatic leukemia) and a benign diagnosis in 18.
  • In the intention-to-treat analysis of all 69 patients: diagnostic accuracy 63%, sensitivity for malignancy 59% (95% CI 43%-73%), specificity 100% (95% CI 86%-100%), and negative likelihood ratio 0.41 (95% CI 0.29-0.58).
  • Among the 56 completed procedures: diagnostic accuracy 78%, sensitivity for malignancy 74% (95% CI 54%-87%), specificity 100% (95% CI 83.75%-100%), and negative likelihood ratio 0.27 (95% CI printed as 0.15%-0.45%).
  • Complications were a prolonged air leak of more than 48 hours and the need for an additional chest tube in 2 patients. The authors also counted the 13 procedures not completed as complications.
  • No deaths due to the procedure were reported.
• The authors' conclusion: The authors concluded that medical thoracoscopy under local anesthesia with a semirigid scope is a simple and safe procedure with an acceptable sensitivity for malignancy. They added that further prospective comparative studies and randomized trials are needed.
• Limitations the authors state:
  • The study had a retrospective design.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Thoracoscopy, Pleural Effusion, Medical Thoracoscopy, Pneumothorax, confidence interval.

Related studies

• Thoracoscopy in the early diagnosis of malignant pleural effusions — C. Boutin, P. Cargnino, et al. (1980)
• Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center: a collaborative medical-surgical initiative — Z.S. DePew, D. Wigle, et al. (2014)
• The safety of medical thoracoscopy in a group at high risk for complications — M. Metintas, G. Ak, et al. (2013)
• Outcomes and complications following medical thoracoscopy — F.J. Brims, M. Arif, et al. (2012)
• Medical thoracoscopy in the diagnosis of unexplained pleural effusion — M.L. Wilsher, A.G. Veale (1998)
• Rigid Mini-Thoracoscopy: The New Kid on the Block — E.O. Bedawi, N.M. Rahman (2020)

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