Medical thoracoscopy: Analysis on diagnostic yield through 30 years of experience

Our plain-English summary of Medical thoracoscopy: Analysis on diagnostic yield through 30 years of experience, by A. Valsecchi, S. Arondi, G. Marchetti (Annals of Thoracic Medicine, 2016).

The study

• Authors: A. Valsecchi, S. Arondi, G. Marchetti
• Journal: Annals of Thoracic Medicine
• Published: 2016;11(3):177-82
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Medical thoracoscopy (MT) or pleuroscopy is a procedure performed to diagnose and treat malignant and benign pleural diseases. Totally 2752 pleuroscopies executed in 1984-2013 in our center were considered in this study.

Methods: A retrospective observational study was performed. Observational time was divided into six series of 5 years. We calculated MT diagnostic yield and analyzed trends of main diseases diagnosed along the time.

Results: Along the 30 years population became progressively older. Number of pleuroscopies firstly increased, then stabilized and decreased in the last 5 years. The overall diagnostic yield of MT was 71%, increasing from 57% to 79%. The diagnostic yield was significantly higher in the presence of monolateral pleural effusion. Cancer represented more than half of diagnosis; tuberculosis was the most common nonneoplastic disease. The frequency of all cancers, mesothelioma, and lung cancer increased through the time; tuberculosis first decreased and then increased. All specimens resulted appropriate during the last 25 years.

Conclusion: MT has a great diagnostic yield that can be improved by practice, permitting to achieve a specific histological diagnosis in about 80% of patients. Our experience demonstrates that the accurate selection of the patients undergoing to MT is very important to reach these results.

In plain English

This retrospective observational study looked at all 2752 medical thoracoscopies done at the authors' center in Brescia, Italy, from 1984 to 2013. A medical thoracoscopy, also called pleuroscopy, is a procedure for looking at and sampling the pleura, the lining around the lungs. Of these, 2474 were done to make a diagnosis. The article did not study asbestos or any other exposure. Overall, 71.0% of diagnostic procedures gave a specific diagnosis, rising from 57.1% in 1984 to 1988 to 79.2% in 2009 to 2013. From 1998 to 2013, the yield was 46% when fluid was on both sides of the chest and 77% when it was on one side. Cancer was found in 1555 of 2474 procedures (62.9%). Malignant pleural mesothelioma was found in 524 (21.2%), mostly the epithelioid type (426). Its share rose from 16.7% in the first period to 27.7% in the last, after a dip to 9.0% in the second. Tuberculosis, found in 149 (6.0%), was the most common non-cancer diagnosis. The authors concluded that the procedure's yield can be improved by practice, reaching a specific diagnosis in up to 80% of patients.

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 observational study of all consecutive medical thoracoscopies at one center, with the 30 years divided into six 5-year periods
• Who was studied: 2752 consecutive medical thoracoscopies performed at the authors' center (Division of Pulmonary Medicine, Spedali Civili Hospital of Brescia, Italy) from 1984 to 2013. 2474 were diagnostic and 278 therapeutic. Patients' mean age was 61.1 years; 1800 (65.4%) were male and 952 (34.6%) female.
• Exposure: No asbestos or other exposure was studied. The subject was the diagnostic procedure medical thoracoscopy (pleuroscopy).
• Main results:
  • Among the 2474 diagnostic procedures, 71.0% gave a specific histological diagnosis. This share rose from 57.1% in the first period (1984 to 1988) to 79.2% in the last (2009 to 2013).
  • Among 1577 diagnostic procedures from 1998 to 2013, the diagnostic yield was 46% for bilateral pleural effusion and 77% for monolateral disease (P less than 0.001).
  • Cancer was diagnosed in more than half of the diagnostic procedures (Table 1: 1555 of 2474, 62.9%).
  • Malignant pleural mesothelioma (524 of 2474, 21.2%) and lung cancer metastasis (504 of 2474, 20.4%) were the most frequent tumors.
  • Among the 524 mesotheliomas, 426 were epithelioid, 63 biphasic, 20 sarcomatoid and 15 of unspecified subtype. The authors describe epithelioid as more than 80%, biphasic as about 12%, and sarcomatoid as very rare.
  • Mesothelioma as a share of diagnostic procedures fell from 16.7% (1984 to 1988) to 9.0% (1989 to 1993), then rose overall to 27.7% (2009 to 2013).
  • Tuberculosis was the most common non-cancer diagnosis (149 of 2474, 6.0%). Its frequency fell from the first to the fourth period and then rose.
  • Inadequate samples occurred mainly in the first period (9 of 126). Table 1 also lists 1 inadequate sample in 1994 to 1998 and none afterwards.
• The authors' conclusion: The authors concluded that medical thoracoscopy has a high diagnostic yield that can be improved by practice, giving a specific histological diagnosis in up to 80% of patients. They also stressed careful patient selection.
• Limitations the authors state:
  • No follow-up of patients was carried out.
  • The database held only pathology results, not later clinical interpretation. More detail on the 'unspecific pleuritis' group was therefore unavailable.
  • The authors could not show that false negative results decreased over time.
  • There were no data on lung cancer subtypes, so the explanation offered for the rise in lung cancer diagnoses is a supposition.

Topics

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

Related studies

• Diagnostic value of medical thoracoscopy in pleural disease: a 6-year retrospective study — F.X. Blanc, K. Atassi, et al. (2002)
• Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience — J. Leemans, C. Dooms, et al. (2018)
• Ultrasound-guided medical thoracoscopy in the absence of pleural effusion — G. Marchetti, A. Valsecchi, et al. (2015)
• Diagnostic yield of pleural fluid cytology in malignant effusions: an Australian tertiary centre experience — P. Loveland, M. Christie, et al. (2018)
• Diagnostic value of medical thoracoscopy in malignant pleural effusion — Y.B. Wu, L.L. Xu, et al. (2017)
• Malignant pleural mesothelioma: diagnostic value of medical thoracoscopy and long-term prognostic analysis — L.L. Xu, Y. Yang, et al. (2018)

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