Outcome of patients diagnosed with fibrinous pleuritis after medical thoracoscopy

Our plain-English summary of Outcome of patients diagnosed with fibrinous pleuritis after medical thoracoscopy, by M. Metintas, G. Ak, O. Cadirci, et al (Respiratory Medicine, 2012).

The study

• Authors: M. Metintas, G. Ak, O. Cadirci, H. Yildirim, E. Dundar, S. Metintas
• Journal: Respiratory Medicine
• Published: 2012;106(8):1177-83
• Cited by: 37 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: In patients with post- medical thoracoscopy histopathological diagnoses of fibrinous pleuritis, confusion can occur concerning subsequent procedures. This issue is particularly important in regions where mesothelioma is prevalent. We aimed to identify false negatives among patients where mesothelioma was common due to asbestos exposure whose histopathological diagnosis following thoracoscopy was fibrinous pleuritis. We also determined risk factors associated with patients that required additional advanced invasive procedures for diagnosis.

Methods: Overall, 287 patients who underwent thoracoscopy were included in the study. Patients diagnosed with fibrinous pleuritis as a result of thoracoscopy were followed for 2 years regarding this condition. More invasive procedures were performed on patients who showed no recuperation or developed pleural disease again during the follow-up period.

Results: Fibrinous pleuritis was observed in 101 (35.2%) patients. Follow-up of these patients revealed that the false negative rate was 18% for malignant pleural diseases. The thoracoscopist's opinion regarding the pleural space, computed tomography scan findings indicating malignancy, pain and female gender were determined to be risk factors for malignant pleural diseases.

Conclusions: In regions where mesothelioma is prevalent and one of the above-stated risk factors is present, patients whose post-thoracoscopy histopathological diagnosis is fibrinous pleuritis should be treated with a more advanced invasive diagnosis procedure.

Copyright © 2012 Elsevier Ltd. All rights reserved.

In plain English

This study, in Eskisehir, Turkey, followed patients whose chest-lining (pleural) biopsies at medical thoracoscopy were reported as "fibrinous pleuritis", a non-specific, non-cancerous finding. The authors described the area as having a high rate of malignant mesothelioma. Of 287 patients studied from 2002 to 2009, 101 (35%) got this result. They were followed for at least 24 months, with surgical biopsy if their disease neither improved nor stabilized, or came back. Eighteen were later found to have pleural cancer: 16 malignant mesothelioma and 2 metastatic cancer. That is a false negative rate of 18% (18/100, excluding one tuberculosis case). In the multivariate analysis, female gender, CT findings suggesting cancer, and pain independently predicted a missed cancer. Asbestos exposure was linked to a missed cancer only in the single-factor analysis. The authors concluded that, where mesothelioma is endemic, such patients should promptly have VATS or open surgical biopsy if the thoracoscopist's impression was not benign, CT suggested cancer, or they had pain on the effusion side. Where environmental asbestos exposure occurs, they said female gender should count as a risk factor for pleural cancer.

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: Single-centre study of consecutive patients who had diagnostic medical thoracoscopy, using a prospectively filled pleural disease database, with at least 24 months of follow-up of patients whose biopsy showed fibrinous pleuritis
• Who was studied: 287 patients (160 men, 127 women; mean age 61.0 years) with pleural effusion of unknown cause and negative fluid cytology who had diagnostic medical thoracoscopy at Eskisehir Osmangazi University, Turkey, January 2002 to January 2009. Of these, 101 had a biopsy diagnosis of fibrinous pleuritis. Of 320 diagnostic procedures, the study did not include 13 patients lost to follow-up, 7 whose effusion resolved without treatment, and 13 still in follow-up.
• Exposure: Asbestos exposure (yes or no) was one of several possible risk factors tested for a missed cancer, along with gender, smoking, CT findings suggesting malignancy, pain, bloody effusion and mesothelial cells in the fluid. The article reports no fiber type or exposure level for this study's patients.
• Main results:
  • 101 of the 287 patients (35%) had a biopsy diagnosis of fibrinous pleuritis after thoracoscopy
  • Among the patients with fibrinous pleuritis, the false negative rate for malignant pleural disease was 18% (18/100, after excluding one tuberculosis case)
  • Of the 18 missed cancers, 16 were malignant mesothelioma and 2 were metastatic malignant pleural involvement
  • Across all 287 patients, thoracoscopy biopsy had its lowest diagnostic sensitivity for malignant mesothelioma: 85.2%, with a 95% confidence interval of 81.09 to 89.31. Of the 108 patients with a final diagnosis of mesothelioma, 92 were diagnosed at thoracoscopy.
  • In the 101 fibrinous pleuritis patients, a malignant-looking pleura in the thoracoscopist's opinion had a sensitivity of 76.9% (95% CI 67.9 to 85.9), a specificity of 93.1% (95% CI 87.7 to 98.5), a PPV of 66.7% and an NPV of 95.7% for cancer. Of the 70 patients whose pleura looked benign, 67 had a benign final diagnosis.
  • In the multivariate analysis of the fibrinous pleuritis patients, three factors independently predicted a missed cancer: female gender (OR 4.36, 95% CI 1.27 to 14.89), CT findings suggesting malignancy (OR 3.86, 95% CI 1.11 to 13.43), and pain (OR 3.81, 95% CI 1.03 to 14.12)
  • In the single-factor (univariate) analysis, asbestos exposure was associated with a missed cancer: 25.0% of exposed patients compared with 3.6% of unexposed patients, OR 9.00 (95% CI 1.14 to 71.04). It was not an independent factor in the multivariate analysis.
• The authors' conclusion: The authors concluded that, in regions where malignant mesothelioma is endemic, patients with a post-thoracoscopy diagnosis of fibrinous pleuritis should be recommended for VATS or open surgical biopsy as soon as possible in any of three situations: the thoracoscopist's impression was not benign, CT findings suggested malignant pleural changes, or the patient had pain on the side of the effusion. They added that, where environmental asbestos exposure occurs, female gender should be accepted as a risk factor for malignant pleural disease.

Topics

Medical terms in this study, explained in our Lexicon: Medical Thoracoscopy, Mesothelioma, Asbestos Exposure, Thoracoscopy.

Related studies

• Outcome of patients with nonspecific pleuritis at thoracoscopy — J.M. Wrightson, H.E. Davies (2011)
• What is the significance of non-specific pleuritis? A trick question — J. Janssen, F. Maldonado, et al. (2018)
• 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)
• Outcome of patients with nonspecific pleuritis/fibrosis on thoracoscopic pleural biopsies — H.E. Davies, J.E. Nicholson, et al. (2010)
• 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)

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