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03:22
Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
885
Medical Thoracoscopy in Malignant Pleural Effusion
Amit K Rath1, Sudarsan Pothal2, Pallavi Bharadwaj3
1Pulmonary Critical Care and Sleep Medicine, Srirama Chandra Bhanja (SCB) Medical College and Hospital, Cuttack, IND.
Cureus
|July 11, 2025
Summary
Medical thoracoscopy (MT) offers a high diagnostic yield (over 90%) for malignant pleural effusion, with specific lesion appearances correlating to cancer types. This procedure is safe and valuable for managing pleural effusions.
Area of Science:
- Pulmonology
- Oncology
- Thoracic Surgery
Background:
- Malignant pleural effusion (MPE) is a common complication of advanced cancers, significantly impacting patient morbidity and quality of life.
- Conventional pleural fluid cytology often yields negative results, necessitating more invasive diagnostic methods for tissue acquisition.
- Medical thoracoscopy (MT) has emerged as a preferred technique for obtaining adequate tissue samples for histopathological examination (HPE) in MPE cases.
Purpose of the Study:
- To evaluate the diagnostic yield and complication rates associated with medical thoracoscopy (MT) in patients with undiagnosed pleural effusion.
- To investigate the association between various morphological pleural lesions observed during MT and their corresponding histopathological diagnoses in MPE.
Main Methods:
- A prospective, single-center, cross-sectional study involving 87 patients with undiagnosed pleural effusion undergoing rigid medical thoracoscopy (MT).
- Morphological characterization of pleural lesions during MT, followed by tissue sampling for histopathological examination (HPE).
- Assessment of procedure-related complications, including pain and desaturation, and correlation of morphological findings with HPE results.
Main Results:
- Medical thoracoscopy (MT) demonstrated a high diagnostic yield of 90.8% for pleural effusion, identifying malignant (72 patients) and tuberculous (7 patients) causes.
- The most frequent morphological findings in malignant pleural effusion (MPE) were pleural-based nodules (63.9%) and adhesions (37.5%).
- Specific morphological patterns showed significant associations with histopathological diagnoses: nodules with adenocarcinoma, adhesions/plaques with mesothelioma, masses with lymphoma/undifferentiated carcinoma, and strands with small cell carcinoma.
Conclusions:
- Medical thoracoscopy (MT) is a highly accurate and safe procedure for the diagnosis and management of malignant pleural effusion (MPE).
- The procedure's favorable safety profile supports its use as a first-line diagnostic tool in appropriate clinical settings.
- Observed morphological patterns during MT can provide valuable clues to the underlying pleural malignancy, aiding in diagnosis and treatment planning.
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