Semirigid thoracoscopy: an effective method for diagnosing pleural malignancies.

Abstract

Background and objective:

Thoracoscopy with a semirigid instrument is a recent technique for diagnosing pleural diseases. The purpose of this study was to report diagnostic yield and complications of the method.

Patients and methods:

Patients with pleural effusion of unknown origin and/or pleural irregularities suspicious for pleural malignancy were included after less invasive means of diagnosis had failed. All procedures were performed under local anesthesia with intravenous sedation/analgesia with a single point of entry with semirigid thoracoscope (Olympus LTF-160). Data were collected prospectively between years 2008 and 2012.

Results:

115 thoracoscopies were performed on 111 patients. Median age was 65 years (range 28 – 86 years), 14.4% were female and 85.6% male. 73 (65.8%) patients had malignant pleural disease (mesothelioma, metastatic cancer) and 38 (34.2%) had benign. Sensitivity, negative predictive value and accuracy of procedure for malignancy were 96.0%, 93.0% and 97.4%. Pleurodesis was made in 34 patients; in 32 (94.1%) was assessed as successful after 1 month. There were 24 adverse events: 3 empyemas/pleural infections, 3 bronchopleural fistulae after chest tube placement and lung re-expansion, 5 patients had excessive pain after pleurodesis, 6 patients had sedation-associated hypotension and 7 patients self–limited fever after plerodesis. One patient died 11 days after procedure for advanced carcinoma.

Conclusions:

Semirigid thoracoscopy is accurate and safe method for evaluation of pleural diseases and useful for therapeutic talc pleurodesis.