Semirigid thoracoscopy: an effective method for diagnosing pleural malignancies.
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.
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.
Semirigid thoracoscopy is accurate and safe method for evaluation of pleural diseases and useful for therapeutic talc pleurodesis.