Epidemiologic evaluation of pleurisy diagnosed by surgical pleural biopsy using data from a nationwide administrative database

Our plain-English summary of Epidemiologic evaluation of pleurisy diagnosed by surgical pleural biopsy using data from a nationwide administrative database, by K. Hara, K. Yamasaki, M. Tahara, et al (Thoracic Cancer, 2022).

The study

• Authors: K. Hara, K. Yamasaki, M. Tahara, H. Ikegami, C. Nishida, K. Muramutsu, Y. Fujino, S. Matsuda, K. Fushimi, H. Mukae, K. Yatera
• Journal: Thoracic Cancer
• Published: 2022;13(8):1136-1142
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pleural biopsies for investigating the causes of pleurisy are performed through modalities including needle biopsies, local anesthetic thoracoscopic procedures, and surgery (video-assisted thoracoscopic surgery and open thoracotomy). To date, there have been no large-scale nationwide epidemiological studies regarding pleurisy diagnosed via surgical pleural biopsy. This study examined the epidemiology of pleurisy diagnosed via surgical pleural biopsy in a Japanese nationwide administrative database.

Methods: We evaluated Japanese Diagnosis Procedure Combination data of 24 173 patients who underwent video-assisted thoracoscopic surgery or open thoracotomy and received a diagnosis of pleurisy between April 2014 and March 2020. In addition to pleurisy diagnoses, the patients' clinical information, including age, sex, smoking status (pack-years), dyspnea grade, length of in-hospital stay, and comorbidities, were extracted from the dataset.

Results: This study included data from 1699 patients. The most frequent causes of pleurisy were neoplastic diseases (55.9%; malignant mesothelioma 22.5%, lung cancer 15.7%, lymphoma 2.5%), followed by infectious diseases (24.0%; tuberculosis 16.2%, parapneumonic pleural effusion 3.6%, empyema 3.5%, nontuberculous mycobacteriosis 0.5%), collagen vascular diseases (2.8%; rheumatoid arthritis 1.3%, immunoglobulin G4-related diseases 0.7%, systemic lupus erythematosus 0.3%), and paragonimiasis (0.1%).

Conclusions: Neoplastic diseases, including malignant mesothelioma and lung cancer, were frequently and accurately diagnosed as pleurisy via surgical pleural biopsy. The next leading cause was infectious diseases such as mycobacterial infections. Physicians should consider performing surgical biopsy in light of the knowledge regarding the etiology of pleurisy when a definitive diagnosis cannot be made via needle pleural biopsy.

© 2022 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

In plain English

This study used a nationwide Japanese hospital database to examine recorded causes of pleurisy (inflammation of the lining of the lungs and chest cavity) in patients who had surgical pleural biopsy. From April 2014 to March 2020, 24,173 patients at 1,624 hospitals underwent video-assisted thoracic surgery or open thoracotomy. Of these, 1,699 diagnosed with pleural effusion or pleurisy at admission were studied. Malignant diseases accounted for 950 of the 1,699 patients (55.9%). Malignant mesothelioma was recorded in 382 patients (22.5%) and metastatic lung cancer in 266 (15.7%). Infectious diseases accounted for 408 (24.0%), mostly tuberculosis (276, 16.2%), and collagen diseases for 47 (2.8%). Benign asbestos pleural effusion was recorded in 29 patients (1.7%), and the cause was unknown in 147 (8.7%). The study did not measure asbestos exposure; it recorded smoking history in pack-years. The authors noted that the database lacked pathology data, that diagnoses rested on attending physicians' judgment, that the final pathological diagnosis was unknown for some patients, and that patients in poor general condition may be missing. The authors concluded that malignant diseases were the most frequent diagnosis, followed by infectious diseases.

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 study of a nationwide Japanese administrative inpatient claims database (Diagnosis Procedure Combination)
• Who was studied: 1,699 patients diagnosed with pleural effusion and/or pleurisy at admission. They were drawn from 24,173 patients who underwent video-assisted thoracic surgery (with or without a pathological specimen) or open thoracotomy, out of 49.6 million hospitalizations at 1,624 hospitals in Japan, April 2014 to March 2020.
• Exposure: Asbestos exposure was not measured. Smoking history (pack-years) was extracted as a patient characteristic. The study classified the recorded causes of pleurisy in patients who had surgical pleural biopsy. Asbestos appears only as one diagnostic category, benign asbestos pleural effusion.
• Main results:
  • Malignant diseases were the most frequent cause: 950 of 1,699 patients (55.9%). The proportion did not differ significantly between the three surgical procedure groups (p = 0.10).
  • Malignant mesothelioma was recorded in 382 of 1,699 patients (22.5%), with similar proportions across the three procedure groups (21.5%, 22.3%, 22.6%; p = 0.98).
  • Metastatic lung cancer was recorded in 266 patients (15.7%).
  • Infectious diseases were recorded in 408 patients (24.0%), including tuberculosis in 276 (16.2%). Collagen diseases were recorded in 47 patients (2.8%).
  • Benign asbestos pleural effusion was recorded in 29 of 1,699 patients (1.7%), with no significant difference between procedure groups (p = 0.52).
  • The cause was unknown in 147 patients (8.7%).
  • Rates of comorbidities did not differ significantly among patients with malignant, infectious and collagen diseases.
• The authors' conclusion: The authors concluded that the most frequent diagnosis made by surgical pleural biopsy was malignant disease (including malignant mesothelioma, metastatic lung cancer and breast cancer), followed by infectious diseases. They added that surgical pleural biopsy may give accurate and efficient diagnoses, especially in patients with malignant pleural effusion.
• Limitations the authors state:
  • Pathological and detailed clinical data were not available in the research database. Diagnostic names were assigned based on the attending physicians' decisions and clinical judgment, and the final pathological diagnosis was unknown for some patients.
  • The study period ended before the COVID-19 outbreak in Japan.
  • Only patients who underwent surgical biopsy were included, so patients in poor general condition may not have been included.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleurisy, Pleural Biopsy, Video-Assisted Thoracoscopic Surgery (VATS), Thoracotomy, Epidemiology, Dyspnea, Mesothelioma, Lung Cancer.

Related studies

• The usefulness of full-thickness biopsy during semi-rigid pleuroscopy for differentiating between malignant pleural mesothelioma and non-specific pleurisy — T. Ueda, T. Nakai, et al. (2025)
• Cause of Asbestos-Induced Pleurisy Forgotten — E. Böhm (2019)
• Nationwide prospective registry database of patients with newly diagnosed untreated pleural mesothelioma in Japan — S. Hasegawa, Y. Shintani, et al. (2024)
• Ventilatory failure due to asbestos pleurisy — A. Miller, A.S. Teirstein, et al. (1983)
• Pathogenesis of pleurisy, pleural fibrosis, and mesothelial proliferation — A. Herbert (1986)
• Acute pleurisy in asbestos exposed persons — G.K. Sluis-Cremer, I. Webster (1972)

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