Medical Thoracoscopy in Malignant Pleural Effusion

Our plain-English summary of Medical Thoracoscopy in Malignant Pleural Effusion, by A.K. Rath, S. Pothal, P. Bharadwaj (Curēus, 2025).

The study

• Authors: A.K. Rath, S. Pothal, P. Bharadwaj
• Journal: Curēus
• Published: 2025;17(6):e85707
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Malignant pleural effusion (MPE) is a common complication of advanced malignancies, often resulting in significant morbidity and impaired quality of life. In most cases, pleural fluid cytology remains negative. In the era of targeted cancer therapy, pathologists expect larger tissue samples. Therefore, medical thoracoscopy (MT) has gained popularity for adequate tissue sampling under supervision. During MT, various morphological pleural lesions were identified, yet their histopathological associations remain unknown. This study aimed to assess the diagnostic yield of medical thoracoscopy and the complications associated with the procedure. We also observed various morphological lesions in MPE and their histopathological associations.

Methods: This was a single-center, hospital-based, prospective cross-sectional study conducted in the Department of Pulmonary Medicine, Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Burla, India. Patients with undiagnosed pleural effusion underwent MT. During the procedure, the lesions were morphologically characterized, and samples were collected for histopathological examination (HPE).

Results: A total of 87 patients underwent medical thoracoscopy using a rigid thoracoscope (Optymed®, Delhi, India), out of which 72 patients had malignant effusion and seven patients had tuberculous effusion. Eight patients had nonspecific inflammation. The diagnostic yield of medical thoracoscopy in this study was at least 90.8% (95% CI: 84.8%-96.8%). Seventy-two patients were evaluated for histopathologic and morphologic association. The most common procedure-related complication was pain at the incision site (87, 100%, median Visual Analogue Scale (VAS): 5), followed by desaturation. The mean fall in saturation was 5.13% (±33.78%). We did not observe any serious adverse effects related to rigid MT. The mean age of the patients was 54.17 (±15.17) years. Among MPE, pleural-based nodules (46, 63.9%), followed by adhesions (27, 37.5%), were the most common findings during MT. Other noted lesions included masses (26, 36.12%), plaques (22, 30.56%), and strands (19, 26.39%). Nodules were significantly associated with metastatic adenocarcinoma (p<0.01). Adhesions and plaques were commonly linked with pleural abnormalities in malignant mesothelioma (p<0.01). Masses were most frequently associated with lymphomas (p<0.01) and undifferentiated carcinoma (p<0.01). Small cell carcinoma comprised only five patients among MPE and was associated with strands (p<0.01).

Conclusion: Medical thoracoscopy is a valuable tool in evaluating and managing malignant pleural effusion. Its high diagnostic accuracy, therapeutic capabilities, and favorable safety profile make it the procedure of choice in appropriate clinical settings. Specific morphological patterns may be observed in different pleural malignancies.

Copyright © 2025, Rath et al.

In plain English

This was a single-center, prospective cross-sectional study at the Department of Pulmonary Medicine, VIMSAR, Burla, Odisha, India, from January 2016 to December 2018. It included 87 patients whose pleural effusion (fluid around the lung) was still undiagnosed after fluid testing. Each had medical thoracoscopy: under local anesthesia, a rigid scope was passed into the chest to view the pleura and take biopsies. The article does not mention asbestos or any work exposure. A definite diagnosis was reached in 90.8% (95% CI: 84.8%-96.8%) of the 87: 72 had malignant effusion and 7 tuberculous effusion. The remaining 8 showed nonspecific inflammation and stayed undiagnosed. All patients had pain at the incision site, and no patient died within four weeks. Of the 72 cancers, 8 were malignant mesothelioma, and all 8 showed plaques and adhesions (p less than 0.01). In this study "plaques" meant thickened, flat fibrous patches seen during the procedure. Nodules were linked with metastatic adenocarcinoma. The authors noted small subgroups and possible differences between observers.

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: Single-center, hospital-based, prospective cross-sectional study of a diagnostic procedure (rigid medical thoracoscopy)
• Who was studied: 87 patients with pleural effusion still undiagnosed after initial fluid examination (146 of 534 people assessed had no diagnosis). Treated at the Department of Pulmonary Medicine, VIMSAR, Burla, Odisha, India, January 2016 to December 2018. Mean age 54.17 years. 72 patients with confirmed malignant pleural effusion were analyzed for lesion-type and histology associations.
• Exposure: No asbestos or other exposure was studied. The article does not mention asbestos or occupational history. The study evaluated the medical thoracoscopy procedure itself and the pleural lesions seen during it.
• Main results:
  • Among the 87 patients who underwent the procedure, 90.8% (95% CI: 84.8%-96.8%) reached a definitive diagnosis. These were the 72 malignant and 7 tuberculous diagnoses; the 8 with nonspecific inflammation were not counted as diagnosed.
  • Of the 87 patients, 72 had malignant effusions and 7 had tuberculous pleural effusions. The remaining 8 showed nonspecific inflammation and stayed undiagnosed.
  • Pain at the incision site was the most common complication, reported in all 87 patients (100%)
  • A drop in oxygen saturation of more than 5% occurred in 34 of 87 patients (39.1%)
  • No patient died within four weeks of the procedure
  • Among the 72 malignant effusions, metastatic adenocarcinoma was the most common diagnosis (45, 62.5%). Next were lymphoma (9), malignant mesothelioma (8), small cell carcinoma (5), undifferentiated carcinoma (4) and squamous cell carcinoma (1).
  • In the 45 patients with metastatic adenocarcinoma, nodules were seen in 39 (86.67%; p less than 0.01)
  • In the 8 patients with malignant mesothelioma, plaques were seen in 8 (100%, p less than 0.01) and adhesions in 8 (100%, p less than 0.01)
  • In this study, 'plaques' was a category of lesion seen through the thoracoscope, defined as thickened, flat fibrous patches
  • Mass lesions were associated with lymphoma (8 of 9, 88.89%; p less than 0.01) and with undifferentiated carcinoma (4, 100%; p less than 0.01)
  • In the 5 patients with small cell carcinoma, strands were significantly associated (text reports 5, 100%; p less than 0.01; Table 3 prints 83.34%)
• The authors' conclusion: The authors concluded that medical thoracoscopy remains a pivotal diagnostic method for malignant pleural effusion. They added that the association between thoracoscopic findings and histopathological patterns may enhance diagnostic precision.
• Limitations the authors state:
  • Cross-sectional, single-center study with a relatively small sample size in several subgroups
  • Morphological descriptions are not standardized, so interobserver variability is likely
  • No immunohistochemistry facility was available, so the malignancies could not be subtyped
  • Primary sites of the disease were not sought
  • Patients with nonspecific inflammation were not followed long enough to reach an exact diagnosis
  • Long-term follow-up was not arranged

Topics

Medical terms in this study, explained in our Lexicon: Medical Thoracoscopy, Pleural Effusion, Quality of Life, Fluid Cytology, Inflammation, Adenocarcinoma, Mesothelioma, Carcinoma.

Related studies

• 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)
• Ultrasound-guided medical thoracoscopy in the absence of pleural effusion — G. Marchetti, A. Valsecchi, et al. (2015)
• Comparison between closed pleural biopsy and medical thoracoscopy for the diagnosis of undiagnosed exudative pleural effusions: a systematic review and meta-analysis — Y. Wei, K. Shen, et al. (2020)
• Diagnostic value of medical thoracoscopy in malignant pleural effusion — Y.B. Wu, L.L. Xu, et al. (2017)
• Medical thoracoscopy in the diagnosis of unexplained pleural effusion — M.L. Wilsher, A.G. Veale (1998)
• 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)

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