Long-term follow-up results of patients diagnosed with nonspecific pleuritis by video-assisted thoracoscopic surgery biopsy

Our plain-English summary of Long-term follow-up results of patients diagnosed with nonspecific pleuritis by video-assisted thoracoscopic surgery biopsy, by M. Agca, R. Yildiz, F.T. Akyil, et al (Archives of Medical Science, 2026).

The study

• Authors: M. Agca, R. Yildiz, F.T. Akyil, A. Sen, A. Kosif, M. Akyil, T. Sevim
• Journal: Archives of Medical Science
• Published: 2026;22(4):2114-2122
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Non-specific pleuritis (NSP) is a fibrinous or inflammatory pleurisy that is not attributable to a benign or malign etiology. The long-term follow-up results of patients diagnosed with NSP following video-assisted thoracoscopic surgery (VATS) were investigated in this study.

Material And Methods: This investigation focused on 593 patients with exudative pleural effusion who underwent VATS between 2011 and 2014. Of the 137 patients diagnosed with NSP, a total of 39 patients were excluded from the study.

Results: Out of the 98 patients, 78 were male (80%) with their mean age being 52.2 ±15.9 years. The mean follow-up period was 1919 ±744 days. Of these patients, 70 (71.4%) had no specific diagnosis, while 28 patients (28.6%) did have specific diagnoses. Malignancy was detected in seven (7.1%) of those with specific diagnoses, with most of the diagnoses of malignancy detected within the first 36 months. Malignant diseases included mesothelioma (n = 2), lung cancer (n = 2), chronic lymphocytic leukemia (n = 1), soft tissue sarcoma (n = 1), and multiple myeloma (n = 1). Chest radiographs of malignant patients showed that statistically significantly larger amounts of fluid (40% vs. 6.9%, p = 0.026), pleural plaque (20% vs. 1.1%, p = 0.020) and nodules (20% vs. 7.7%, p = 0.020) were detected compared to patients with a benign course.

Conclusions: Most patients diagnosed with NSP after VATS had a benign disease course. There was a probability of malignancy, although it was low. Mesothelioma and other malignancies could be seen within the first 36 months after the biopsy. Apart from mesothelioma, other malignancies should also be considered, and further follow-up recommended for patients with a large amount of fluid, plaque and nodules found in the initial VATS images.

Copyright: © 2020 Termedia & Banach.

In plain English

This retrospective study from a single chest-disease hospital in Istanbul followed patients whose pleural biopsy by video-assisted thoracoscopic surgery (VATS), between 2011 and 2014, showed only "non-specific pleuritis" (inflammation with no identified cause). Of 593 patients with exudative pleural effusion who had VATS, 137 got this result and 98 were followed, on average 1919 days. In 70 of the 98 (71.4%) no specific disease emerged. Twenty-one received benign diagnoses, most often heart failure. Seven were later diagnosed with cancer: two mesotheliomas (one pleural at 16 months, one peritoneal at 12 months), two lung cancers, and one each of chronic lymphocytic leukemia, soft tissue sarcoma and multiple myeloma. Comparing five of these patients with 91 benign-course patients, large effusions on chest X-ray (40% vs 6.9%) and pleural plaques (20% vs 1.1%) and nodules (20% vs 7.7%) at thoracoscopy were significantly more common in the cancer group. Age, sex, smoking and pleural fluid LDH showed no significant relationship. Asbestos exposure histories were mostly unavailable. The authors concluded that most patients had a benign course, with a low risk of malignancy.

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, single-center follow-up study of medical records
• Who was studied: 593 patients with exudative pleural effusion who had diagnostic VATS at a chest diseases hospital in Istanbul, Turkey, January 2011 to December 2014. 137 had a biopsy diagnosis of non-specific pleuritis, 39 were excluded, and 98 formed the final cohort (78 male, 20 female; mean age 52.2 years).
• Exposure: Not an asbestos exposure study. The patients studied had a VATS biopsy diagnosis of non-specific pleuritis. Environmental or occupational asbestos exposure histories were not available for most patients.
• Main results:
  • During follow-up of the 98 patients, no specific benign or malignant disease was found in 70 (71.4%). A specific diagnosis was made in 28 (28.6%).
  • Of the 28 with a specific diagnosis, 21 had benign diseases (21.4% of the cohort). These were heart failure (n = 12; 12.2%), connective tissue diseases (n = 3; 3.1%) and pulmonary embolism (n = 3; 3.1%), plus 3 other internal diseases.
  • Seven patients (7.1% of 98) were later diagnosed with malignancy: mesothelioma (n = 2), lung cancer (n = 2), chronic lymphocytic leukemia (n = 1), soft tissue sarcoma (n = 1) and multiple myeloma (n = 1).
  • The pleural mesothelioma was diagnosed after 16 months from cytology of repeated pleural fluid.
  • The peritoneal mesothelioma was diagnosed by peritoneal biopsy after 12 months.
  • Five of the seven malignancies were diagnosed within the first 3 years after VATS. The other two were diagnosed 5 and 7 years after VATS.
  • The two patients diagnosed 5 and 7 years after VATS were excluded from the statistical comparison.
  • All patients with malignancies other than multiple myeloma died.
  • The authors compared 5 patients with malignancy against 91 patients with a benign course. Large effusions on chest X-ray were seen in 40% of the malignancy group vs 6.9% of the benign group (p = 0.026). On thoracoscopic images, pleural plaques were seen in 20% vs 1.1% and pleural nodules in 20% vs 7.7% (p = 0.020). The authors reported these differences as statistically significant.
  • No significant relationship was found between a later malignancy diagnosis and age, gender, smoking, or pleural fluid LDH.
• The authors' conclusion: The authors concluded that most patients with non-specific pleuritis did not appear to have an underlying disease and had a benign course, but carried a small risk of malignancy. They recommended closer monitoring.
• Limitations the authors state:
  • The study was retrospective and single-centered.
  • Environmental or occupational asbestos exposure histories were unavailable for most patients.
  • Symptoms patients experienced after VATS were not fully documented.

Topics

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

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• The MesoVATS trial: is there a future for video-assisted thoracoscopic surgery partial pleurectomy? — R.C. Rintoul (2015)
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• Value of autofluorescence in video-assisted thoracoscopic surgery in pleural diseases — S.T. Liman, A. Elicora, et al. (2013)
• Optimal follow-up duration for nonspecific pleuritis: how long is long enough? — S. Ozyavuz, G. Ak, et al. (2026)

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