Pleuroscopy: early experience in an East malaysian state with high tuberculosis prevalence

Pleuroscopy using a flexi-rigid tube was introduced in Malaysia in late 2004 as part of the investigation for unexplained pleural effusion. Sabah, an East Malaysian state situated in Borneo, has the highest prevalence of tuberculosis (TB) in Malaysia. Therefore, exudative pleural effusion in Sabah was presumed to be predominantly because of TB.

To look at the diagnostic yield and safety of pleuroscopy in a TB endemic state in Malaysia.

A prospective study was conducted covering the period from September 2006 to May 2007. Consecutive patients with unexplained pleural effusion underwent pleuroscopy. Biopsy was performed if nodules, nodules with adhesions, or adhesions were visualized in the pleural space. Data were analyzed using the χ test and multivariate analysis. A P value of less than 0.05 was taken as statistically significant.

Sixty-two patients underwent pleuroscopy. Biopsy specimens were obtained in 55 of 57 patients (96.4%). The diagnostic yield of nodules, nodules with adhesions, and adhesions was 92.0%, 66.7%, and 60.0%, respectively. TB and neoplasm were diagnosed in 22 (52.4%) and 20 (47.6%) patients, respectively. Neoplasm was more common in female patients and TB was more common in male patients (P=0.048). Neither neoplasm nor TB was significantly associated with ethnic groups (P=0.156). Sensitivity of the initial impression for TB and neoplasm was 59.1% and 90.0%, respectively. One patient experienced desaturation during pleuroscopy.

Pleuroscopy is a safe diagnostic procedure and especially useful in sampling nodules indicating that the sample size obtained during pleuroscopy is satisfactory. Empirical TB treatment should be discouraged even in a state with high TB prevalence as certain neoplasms can present as pleural effusion. Pleuroscopy should be performed early in unexplained pleural effusion.