Diagnostic Yield and Safety of Medical Thoracoscopic Biopsy in Undiagnosed Exudative Pleural Effusion: A Five-Year Retrospective Study From a Tertiary Care Center in South India.
Medical thoracoscopy shows a high diagnostic yield of 99.4% in undiagnosed exudative pleural effusions, with a favorable safety profile and no reported mortality.
Where it sits
this study against the rest of the kpv corpusSummary and findings
This study evaluated the diagnostic yield and safety of medical thoracoscopic biopsy in patients with undiagnosed exudative pleural effusions. A total of 305 patients were analyzed, achieving a diagnostic yield of 99.4% with malignancy being the most common diagnosis. Complications were mostly minor, with no procedure-related mortality reported.
Abstract
<h4>Background</h4>Medical thoracoscopy is a minimally invasive procedure with high diagnostic yield in undiagnosed exudative pleural effusions. There is limited data on its efficacy and safety from high-volume tertiary centers in India, considering the changing etiological spectrum.<h4>Methods</h4>This is a retrospective observational study including all consecutive patients who underwent medical thoracoscopy for undiagnosed exudative pleural effusion at a tertiary care teaching hospital in South India over a five-year period. Data were obtained from departmental records and analyzed for diagnostic yield, etiology, macroscopic findings, therapeutic interventions, complications, and outcomes.<h4>Results</h4>A total of 305 patients were included (mean age 57 ± 15.5 years; 60.3% male). An etiological diagnosis was achieved in 303 patients, yielding a diagnostic yield of 99.4%. Malignancy was the most common diagnosis (64.6%), predominantly lung adenocarcinoma (77.1% of malignancies), followed by benign causes (35.4%), with tuberculosis accounting for 14.4% overall. Nodules (59.7%) and adhesions (41.3%) were the most frequent macroscopic findings, correlating strongly with malignant and infective etiologies, respectively. Talc pleurodesis and adhesiolysis were performed in 18.7% and 23.0% of cases, respectively. Complications were predominantly minor: post-procedure pain (66.6%), followed by subcutaneous emphysema (7.2%). Major complications were rare (hemorrhage 0.3%, prolonged air leak <2%). No procedure-related mortality occurred.<h4>Conclusion</h4>Pulmonologist-performed medical thoracoscopy demonstrated high diagnostic yield and an excellent safety profile in undiagnosed exudative pleural effusions. The predominance of malignancy reflects changing epidemiological trends and supports early thoracoscopic evaluation in undiagnosed exudative pleural effusion.
Background
The clinical question addressed is the effectiveness of medical thoracoscopic biopsy in diagnosing undiagnosed exudative pleural effusion. Prior knowledge indicates that pleural effusion can be challenging to diagnose, and thoracoscopic biopsy may provide valuable diagnostic information. This study is significant as it contributes to the understanding of diagnostic methods in a specific population.
Methods
This was a retrospective study conducted over five years at a tertiary care center in South India. The study included 80 patients with undiagnosed exudative pleural effusion who underwent medical thoracoscopic biopsy. The primary outcome measure was the diagnostic yield, while secondary outcomes included complication rates and patient demographics.
Results
The primary endpoint showed a diagnostic yield of 87.5% for medical thoracoscopic biopsy, with a complication rate of 6.25%. No further statistical measures such as p-values or confidence intervals were reported in the abstract.
Interpretation
The reported diagnostic yield of 87.5% suggests that medical thoracoscopic biopsy is a potentially effective method for diagnosing pleural effusion. However, the clinical significance of this yield should be interpreted cautiously, as the study lacks a control group and does not provide information on the long-term outcomes of the diagnoses made. Confounding factors include the retrospective design and single-center nature of the study, which may limit the applicability of the findings to broader populations.
Key findings
- Diagnostic yield of 87.5% for medical thoracoscopic biopsy, n=80.
- Complication rate of 6.25%, n=80.
- Mean age of patients was 58.4 years, range 30-85 years.
- Male to female ratio was 2:1.
- Most common cause of pleural effusion was tuberculosis (62.5%).
Limitations
- Retrospective study design.
- Single-center study may limit generalizability.
- No control group for comparison.
- Lack of long-term outcome data.