High diagnostic accuracy of flexible thoracoscopy for distinguishing tuberculous from malignant pleural effusions

To evaluate the diagnostic accuracy of flexible thoracoscopy in distinguishing between tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE), and to provide clinicians with a reliable method for accurate diagnosis and a basis for appropriate treatment.

This retrospective study was conducted at the Second People's Hospital of Gansu Province from April 2021 to June 2023. A total of 161 patients with confirmed pleural effusion were included. All patients underwent flexible thoracoscopy using the Olympus LTF-240 electronic thoracoscope. Histopathologic findings were used as the diagnostic gold standard.

Under flexible thoracoscopy, pleural features of TPE commonly included hyperemia, edema, fibrous adhesions, and miliary nodules. In contrast, MPE was characterized by multiple nodules, masses, leukoplakia-like changes, and pleural thickening. The areas under the curve for diagnosing TPE and MPE using flexible thoracoscopy were 0.895 and 0.883, respectively. Diagnostic performance was superior in patients with bloody pleural effusion compared to those without. There was no significant difference in the overall complication rates between the TPE and MPE groups (P>0.05). Additionally, in TPE patients, lactate dehydrogenase, adenosine deaminase, and tumor markers were not significantly correlated (both P>0.05), whereas in MPE patients, a negative correlation was observed (P<0.05).

Flexible thoracoscopy demonstrated high diagnostic accuracy in differentiating TPE from MPE and was associated with good safety and patient tolerance, making it a valuable diagnostic tool in clinical practice.