Medical thoracoscopy, results and complications in 146 patients: a retrospective study

Our plain-English summary of Medical thoracoscopy, results and complications in 146 patients: a retrospective study, by M. Hansen, P. Faurschou, P. Clementsen (Respiratory Medicine, 1998).

The study

• Authors: M. Hansen, P. Faurschou, P. Clementsen
• Journal: Respiratory Medicine
• Published: 1998;92(2):228-32
• Cited by: 86 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

In a retrospective study the results of medical thoracoscopy in 147 patients were reviewed; 136 of the patients had pleural effusion and 11 patients had diffuse pulmonary infiltration. All the pleural exudates were initially screened three times successively and found to be sterile and without tumour cells. All thoracoscopies were performed with local anaesthesia, with the 'open technique', and nine different doctors performed the thoracoscopies. The overall diagnostic sensitivity was 90.4%. The results demonstrated 62% with malignancy of the pleura, and 38% revealed benign pleural diseases, among them 2% with tuberculosis. The sensitivity for malignancy was found to be 88% and the specificity 96%. The most common primary lung cancer with involvement of the pleura was the adenocarcinoma (62%), and the most common metastatic tumour originated from the breast (28%). The sensitivity for tuberculosis was 100% and the specificity 100%. No mortality was found, and the morbidity was low at about 0.6% (empyema, pleuro-cutaneous fistula, transcutaneous growth of tumour (mesothelioma)). In 64% of the patients the thoracoscopy resulted in treatment (pleurodesis, antituberculous treatment, chemotherapy and peroral steroid therapy). The medical diagnostic thoracoscopy in local anaesthesia is a simple, low-cost investigation with a relatively high diagnostic accuracy, no mortality and a low morbidity.

In plain English

This retrospective study at University Hospital Gentofte, Denmark, reviewed medical thoracoscopy (examining the chest cavity through a scope under local anaesthesia) in 147 patients examined from 1986 to 1992. Of these, 136 had pleural effusion (fluid around the lung) that three earlier fluid tests had not explained, and 11 were suspected of pulmonary fibrosis. The article does not discuss asbestos. Thoracoscopy led to a diagnosis of malignancy in 91 patients (62%), including 31 with mesothelioma (21% of all patients). It led to a non-malignant diagnosis in 56 (38%), including 3 with tuberculosis. In 33 patients (23%) no diagnosis could be established. Overall diagnostic sensitivity was 90.4%. For malignancy, sensitivity was 88%, and specificity was reported as 95% in the results and 96% elsewhere in the article. No deaths were related to the procedure. One patient each had empyema, a pleuro-cutaneous fistula, and tumour growth through the skin (mesothelioma). Treatment followed in 94 patients. The authors concluded that medical thoracoscopy under local anaesthesia is a simple, relatively low-cost procedure with high sensitivity and specificity and very low morbidity.

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 study of diagnostic medical thoracoscopy (accuracy and complications)
• Who was studied: 147 patients (78 male, 69 female; mean age 63, range 17-85) who had diagnostic thoracoscopy at University Hospital Gentofte, Denmark, from 1986 to 1992, followed up in 1995. 136 had pleural effusion that was non-diagnostic after three pleurocenteses. 11 had no effusion and were suspected of pulmonary fibrosis.
• Exposure: Not an exposure study. The article does not mention asbestos or any fiber type. It evaluated medical thoracoscopy performed under local anaesthesia with the 'open technique' by nine doctors.
• Main results:
  • Thoracoscopy gave a diagnosis of malignancy in 91 of 147 patients (62%).
  • Primary pleural cancer (mesothelioma) was diagnosed in 31 patients (21% of the total).
  • A non-malignant diagnosis was made in 56 patients (38%), of whom 3 had tuberculosis.
  • In 33 patients (23%) no diagnosis could be established ('idiopathic pleural effusions').
  • The overall diagnostic sensitivity was 90.4%.
  • For malignancy, sensitivity was 88%. Specificity was 95% in the results section (96% in the discussion and abstract). Positive predictive value was 98% and negative predictive value 78%.
  • For tuberculosis, the reported specificity was 100% (the abstract also gives sensitivity of 100%).
  • Among the 26 primary lung cancers, adenocarcinoma was most frequent (61%). Among the 34 metastatic tumours, breast cancer was most frequent (28%).
  • No deaths were related to thoracoscopy, and no major bleeding was observed.
  • Complications among 147 patients were: 1 empyema (0.6%), 1 pleuro-cutaneous fistula (0.6%), 1 transcutaneous growth of tumour in a mesothelioma patient (0.6%), and 2 patients needing an additional chest tube (1.2%).
  • Thoracoscopy was followed by treatment in 94 of 147 patients (63.9%): pleurodesis 68, chemotherapy 16, oral steroids 7, antituberculous treatment 3.
• The authors' conclusion: The authors concluded that medical diagnostic thoracoscopy under local anaesthesia is a simple, relatively low-cost procedure with high sensitivity and specificity, insignificant mortality and very low morbidity. They said more is needed on surgical (video-assisted) thoracoscopy in larger follow-up studies.

Topics

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

Medical terms in this study, explained in our Lexicon: Medical Thoracoscopy, Pleural Effusion, Exudate, Pleura, Lung Cancer, Adenocarcinoma, Empyema, Mesothelioma.

Related studies

• Outcomes and complications following medical thoracoscopy — F.J. Brims, M. Arif, et al. (2012)
• The safety of medical thoracoscopy in a group at high risk for complications — M. Metintas, G. Ak, et al. (2013)
• Medical thoracoscopy in the diagnosis of unexplained pleural effusion — M.L. Wilsher, A.G. Veale (1998)
• Diagnostic value of medical thoracoscopy in pleural disease: a 6-year retrospective study — F.X. Blanc, K. Atassi, et al. (2002)
• Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial — M. Metintas, G. Ak, et al. (2010)
• 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)

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