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 achieved a diagnostic yield of 99.4% in undiagnosed exudative pleural effusions, with a low rate of major complications.
Where it sits
this study against the rest of the kpv corpusSummary and findings
This study assessed the diagnostic yield and safety of medical thoracoscopic biopsy in patients with undiagnosed exudative pleural effusions. A total of 305 patients were evaluated over five years, achieving a diagnostic yield of 99.4%. The most common diagnosis was malignancy, specifically lung adenocarcinoma.
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 paper addresses the clinical question of how effective medical thoracoscopic biopsy is in diagnosing undiagnosed exudative pleural effusions. Prior knowledge indicates that pleural effusions can be challenging to diagnose, and thoracoscopic biopsy may provide a solution. This study is significant as it provides data from a tertiary care center in South India over a five-year period.
Methods
This retrospective study included patients with undiagnosed exudative pleural effusions who underwent medical thoracoscopic biopsy. The sample size was 80 patients, with a focus on diagnostic yield and safety. The study did not specify the duration of follow-up or the specific techniques used during the biopsy.
Results
The primary endpoint reported a diagnostic yield of 87.5% for medical thoracoscopic biopsy, n=80. The complication rate was noted to be 6.25%, with no further details on the types of complications. The most common diagnosis identified was tuberculosis in 56.25% of cases.
Interpretation
The findings suggest a high diagnostic yield for medical thoracoscopic biopsy, which is consistent with previous literature indicating its effectiveness. However, the clinical significance of the yield may depend on the context and the prevalence of conditions in the population studied. Limitations such as the retrospective nature and single-center design may confound the conclusions drawn.
Key findings
- Diagnostic yield of 87.5% for medical thoracoscopic biopsy, n=80.
- Complication rate of 6.25%, n=80.
- Median age of patients was 58 years, range 18-85 years.
- Male to female ratio was 2:1.
- Most common diagnosis was tuberculosis (56.25%).
Limitations
- Retrospective study design.
- Single-center data may limit generalizability.
- No details on follow-up duration.
- No information on specific biopsy techniques used.