Investigating causes of undiagnosed exudative pleural effusion by medical Pleuroscopy and close biopsy

Document Type : Original Article

Authors

Pulmonologist, Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: Pleural effusion may develop during various acute or chronic medical conditions. Despite different diagnostic workups, some cases of pleural effusion may remain undiagnosed. Pleuroscopy and closed biopsy are common diagnostic approaches used for the diagnosis of undiagnosed cases. The present research aimed to evaluate the diagnostic yield of medical pleuroscopy and closed biopsy in Iran.
Materials and methods: The present cross-sectional study was performed within 2016-2018, in the North-East of Iran. Patients who had undiagnosed lymphocytic predominance exudative pleural effusion were included in the present research. Every patient underwent medical pleuroscopy or closed pleural biopsy by an Abrams needle. The collected data were analyzed in SPSS software (version 12).Ap-valuelessthan0.05 was considered statistically significant.
Results:A total of 108 patients with the mean age of 58.73±18.13 years enrolled in the present study. Around 50 patients underwent needle biopsy,while the other 58 patients went through medical pleuroscopy. Chronic pleuritis, malignant pleural effusion, negative results, and tuberculosis were the common results. When pleuritis is regarded as negative results and malignant and tuberculosis pleural effusion as positive results, medical thoracoscopy provides more significant positive results and fewer negative results (P=0.024). No patient developed complications after the procedures.
Conclusion: In contrast to other studies, both of these techniques had low diagnostic yield for the diagnosis of undiagnosed pleural effusion. Therefore, performing other diagnostic workups (e.g., imaging techniques) may decrease the rate of undiagnosed pleural effusion.

Keywords

References

1.   Feller-Kopman D, Light R. Pleural disease. N Engl J Med. 2018;378:740-51.
2. Beaudoin S, Gonzalez AV. Evaluation of the patient with pleural effusion. CMAJ. 2018;190:E291-5.
3. Loddenkemper R, Mathur PN, Lee P, Noppen M. History and clinical use of thoracoscopy/pleuroscopy in respiratory medicine. Breathe. 2011;8:144-55.
4.Rodriguez-Panadero F, Janssen JP, Astoul P. Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion. Eur Respir J. 2006;28:409-22.
5.Loddenkemper R. Thoracoscopy--state of the art. Eur Respir J. 1998;11:213-21.
6. McGrath EE, Anderson PB. Diagnosis of pleural effusion: a systematic approach. Am J Crit Care. 2011;20:119-27.
7.Hooper C, Lee YG, Maskell NJ;BTS Pleural Guideline Group.Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65:ii4-17.
8.Dixon G, de Fonseka D, Maskell N. Pleural controversies: image guided biopsy vs. thoracoscopy for undiagnosed pleural effusions? J Thorac Dis. 2015;7:1041-51.
9.  Shaheen MM, Shaaban AY, Mahmoud MI, Shaaban AA, Sweed RA. The diagnostic role of thoracoscope in undiagnosed pleural effusion: rigid versus flexible. Egyp J Chest Dis Tuberc. 2014;63:635-42.
10.Bibby AC, Maskell NA. Pleural biopsies in undiagnosed pleural effusions; Abrams vs image-guided vs thoracoscopic biopsies. Curr Opin Pulm Med. 2016;22:392-8.
11.Haghdoost AA, Afshari M, Baneshi MR, Gouya MM, Nasehi M, Movahednia M. Estimating the annual risk of tuberculosis infection and disease in southeast of iran using the bayesian mixture method. Iran Red Crescent Med J. 2014;16:e15308.
12.Zhai K, Lu Y, Shi HZ. Tuberculous pleural effusion. J Thorac Dis. 2016;8:E486-94.
13.DePew ZS, Wigle D, Mullon JJ, Nichols FC, Deschamps C, Maldonado F. Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center: a collaborative medical-surgical initiative. Chest. 2014;146:398-405.
14.Diacon AH, Van de Wal BW, Wyser C, Smedema JP, Bezuidenhout J, Bolliger CT, et al. Diagnostic tools in tuberculous pleurisy: a direct comparative study. Eur Respir J. 2003;22:589-91.
15.Hansen M, Faurschou P, Clementsen P. Medical thoracoscopy, results and complications in 146 patients: a retrospective study. Respir Med. 1998;92:228-32.
16.Xiong Y, Gao X, Zhu H, Ding C, Wang J. Role of medical thoracoscopy in the treatment of tuberculous pleural effusion. J Thorac Dis. 2016;8:52-60.
17.Mahmodlou R, Seyed Mokhtari SA, Sarbazzadeh J. The role of thoracoscopy in the diagnosis of pleural effusion of unknown origin. J Babol Univ Med Sci. 2018;20:31-6.
18.Light RW. The undiagnosed pleural effusion. Clin Chest Med.2006;27:309-19.
19.Patil C, Dixit R, Gupta R, Gupta N, Indushekar V. Thoracoscopic evaluation of 129 cases having undiagnosed exudative pleural effusions. Lung India. 2016;33:502-6.
20.Ahmed MM, Halim HA, Aziz ET, El-Shorbagy RM. Outcomes and complications of medical thoracoscopy in undiagnosed exudative pleural effusion. Egyp JBronchol. 2016;10:93.
21.Helala LA, El-Assal GM, Farghally AA, El Rady MM. Diagnostic yield of medical thoracoscopy in cases of undiagnosed pleural effusion in Kobri El-Kobba Military Hospital. Egyp J Chest Dis Tuberc. 2014;63:629-34.
Journal of Cardio-Thoracic Medicine
Volume 8, Issue 2
June 2020
Pages 614-619

Files

Share

How to cite

Statistics