Diagnostic value of medical thoracoscopy in malignant pleural effusion

Our plain-English summary of Diagnostic value of medical thoracoscopy in malignant pleural effusion, by Y.B. Wu, L.L. Xu, X.J. Wang, et al (BMC Pulmonary Medicine, 2017).

The study

• Authors: Y.B. Wu, L.L. Xu, X.J. Wang, Z. Wang, J. Zhang, Z.H. Tong, H.Z. Shi
• Journal: BMC Pulmonary Medicine
• Published: 2017;17(1):109
• Cited by: 31 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Medical thoracoscopy has been shown to be an efficacious procedure in diagnosing unexplained exudative pleural effusions with excellent safety. This study aimed to assess the diagnostic significance of thoracoscopy in the management of patients with malignant pleural effusion (MPE).

Methods: Consecutive patients with malignant pleural effusion were retrospectively reviewed, and their demographic, radiographic, thoracoscopic and histological data were collected.

Results: Between July 2005 and June 2014, 342 of 833 patients undergoing thoracoscopy were finally confirmed to suffer from MPE. The top three frequent causes of MPE were metastatic carcinoma (79.5%), malignant mesothelioma (10.2%), and lymphoma (2.9%). Among metastatic malignancies, the most common cancer was lung cancer (85.2%), followed by breast cancer (4.4%), ovarian cancer (2.2%), pancreatic cancer (1.8%), etc. No serious adverse events associated with thoracoscopy were recorded.

Conclusions: Medical thoracoscopy is a valuable and safe tool in diagnosing malignant pleural effusion with minimal complication rates.

In plain English

This retrospective study reviewed records of patients at a 1600-bed general hospital in Beijing, China, who had semi-rigid medical thoracoscopy (examining the chest cavity through a scope and taking biopsies of the pleura) between July 2005 and June 2014. All had fluid around the lungs that earlier tests had not explained. Of 833 such patients, 342 were diagnosed with malignant pleural effusion, meaning the pleural biopsy showed cancer. Among these 342, 272 had metastatic carcinoma, 35 had pleural malignant mesothelioma (10.2%) and 10 had lymphoma. In 25, the original cancer could not be identified. Of the 272 metastatic cancers, 232 (85.2%) were lung cancer, followed by breast, ovarian and pancreatic cancer. Pleural plaques were seen during thoracoscopy in 69 patients (20.2%). No serious adverse events were recorded. Brief chest pain from the chest tube (43.9%) was the most common minor complication. The authors concluded that thoracoscopy is simple and safe, with a high positive rate in diagnosing malignant pleural effusion. They stated that without a comparison group they could not calculate its sensitivity or specificity. The article does not discuss asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of consecutive patients at a single hospital, analyzed with descriptive statistics
• Who was studied: 342 patients with malignant pleural effusion, out of 833 patients with undiagnosed pleural effusions who underwent medical thoracoscopy at Beijing Chao-Yang Hospital, China, between July 2005 and June 2014. Mean age was 62.8 years (SD 9.7), and 183 were male and 159 female.
• Exposure: No asbestos or fiber exposure is reported. What the study examined was the diagnostic procedure, semi-rigid medical thoracoscopy with pleural biopsy.
• Main results:
  • Among the 342 patients with malignant pleural effusion, the causes were metastatic carcinoma in 272, pleural malignant mesothelioma in 35 (10.2%) and lymphoma in 10. The original cancer was not identified in 25 (7.3%).
  • Among the 272 metastatic cancers, lung cancer accounted for 232 (85.2%), breast cancer for 12 (4.4%), ovarian cancer for 6 (2.2%) and pancreatic cancer for 5 (1.8%).
  • Findings seen at thoracoscopy in the 342 patients included pleural nodules in 243 (71.1%) and pleural plaques in 69 (20.2%).
  • No serious adverse events were observed. Minor complications were transient chest pain from the indwelling chest tube (43.9%), subcutaneous emphysema (8.5%), minor bleeding (6.4%) and transient fever of 38 °C or more (5.6%).
• The authors' conclusion: The authors concluded that medical thoracoscopy is simple and safe, with a high positive rate in the diagnosis of malignant pleural effusion, and that it should be performed actively for suitable patients with suspected malignant pleural effusion.
• Limitations the authors state:
  • As a retrospective study, data could not be collected and analyzed prospectively.
  • Only patients with malignant pleural effusion were reviewed and there was no control group, so the sensitivity and specificity of thoracoscopy could not be calculated.
  • Blind needle biopsies or image-assisted biopsies were done in only a few patients before thoracoscopy.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Medical Thoracoscopy, Pleural Effusion, Thoracoscopy, Carcinoma, Mesothelioma, Lung Cancer, Ovarian Cancer.

Related studies

• Malignant pleural mesothelioma: diagnostic value of medical thoracoscopy and long-term prognostic analysis — L.L. Xu, Y. Yang, et al. (2018)
• Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience — J. Leemans, C. Dooms, et al. (2018)
• Diagnostic value of medical thoracoscopy in pleural disease: a 6-year retrospective study — F.X. Blanc, K. Atassi, et al. (2002)
• Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial — M. Metintas, G. Ak, et al. (2010)
• Diagnostic performance and safety of image-guided pleural biopsy and medical thoracoscopy for undiagnosed exudative pleural effusion: a systematic review and network meta-analysis — S. Lyu, Z. Zheng, et al. (2026)
• Intrapleural Urokinase Directly Under Medical Thoracoscopy for the Diagnosis of Malignant Pleural Mesothelioma With Severe Multiloculated Pleural Effusions — S. Terashita, H. Kawachi, et al. (2019)

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