Diagnostic Utility of Thoracoscopy in Recurrent Exudative Pleural Effusion: A Single-Arm Interventional Study

Background and objectives Recurrent pleural effusion has always posed a challenge for definitive etiological diagnosis because it relies on nonspecific investigative methods like pleural fluid analysis.The basic nature of fluid, like transudate or exudate, can be differentiated by Light's criteria. The common causes of exudative effusion are tuberculosis, malignancy, and pneumonia. The non-specific method of diagnosis mainly depends upon pleural fluid biochemical and cytological tests in order to decide an empirical treatment. The blind method of pleural biopsy by introducing a specialized pleural biopsy needle into the pleural cavity is also not promising for accurate histopathological study in order to reach a definitive etiological diagnosis in exudative pleural effusion patients. The aim and objectives of this study are to determine the role and efficacy of medical thoracoscopy for definitive diagnosis in patients having exudative pleural effusion. Methods The study was carried out by taking a sample size of 61 patients fulfilling the inclusion and exclusion criteria, having recurrent exudative pleural effusion as per Light's criteria, admitted in the pulmonary medicine department of Kalinga Institute of Medical Sciences over a period of two years (2023-2025). All cases were subjected to medical thoracoscopy in the designated procedural suite of this hospital after doing the required investigations. Multiple pleural biopsy samples were obtained in each patient and sent to the histopathology lab to obtain tissue diagnosis. All the data of the study were kept for critical analysis to reflect in the results and conclusion. Results The mean age of cases was 58 years with a male-female ratio of 1.25:1. Shortness of breath was the most common symptom (56 cases, 91.8%) followed by cough (47 cases, 77.04%). Hypertension was the most common comorbidity found among the cases (16 cases, 26.2%). The most common radiology finding was gross pleural effusion (54 cases, 88.5%), followed by mass lesion (16 cases, 26.2%), thickened pleura (16 cases, 26.2%), and nodules (nine cases, 14.8%). Pleural tissue biopsy revealed malignancy in 41 patients (67.2%). Out of which adenocarcinoma was the most common subtype (30 patients, 49.2%), followed by squamous cell carcinoma (eight patients, 13.1%), and was inconclusive in four patients. Post-thoracoscopic minor complications were reported in only 8 patients; 6 patients (9.8%) had subcutaneous emphysema, and two patients (3.3%) developed persistent air leak. Those were resolved with conservative treatment. Conclusion This study favored medical thoracoscopy as an ideal and effective tool to achieve a definitive diagnosis in recurrent exudative pleural effusion with very minimal and self-limited complications. Its role and efficacy are undisputed in all cases of recurrent exudative pleural effusion in order to achieve a highly promising diagnosis, so that an early treatment plan can be initiated accordingly.