https://doi.org/10.4081/monaldi.2025.3233
The role of medical thoracoscopy in the diagnosis of exudative lymphocytic pleural effusions: an observational study
Submitted: October 20, 2024
Accepted: January 21, 2025
Published: March 20, 2025
Accepted: January 21, 2025
Abstract Views: 366
PDF_EARLY VIEW: 43
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Diagnosis of pleural effusion remains challenging despite extensive microbiological and radiological investigations. Pleural histopathological examination (HPE) is often needed to ascertain the etiology. Medical thoracoscopy (MT) is surpassing the other modalities of pleural biopsy on account of its high diagnostic yield. We aim to estimate the yield of MT in undiagnosed exudative lymphocytic pleural effusion and also intend to correlate gross thoracoscopy findings with HPE results. This retrospective observational study was conducted in a tertiary respiratory care center. Medical records of undiagnosed exudative lymphocytic predominant pleural effusion patients who underwent MT during the study period of 24 months were retrieved from the Medical Records Department. The clinico-demographic profile, radiological images, gross thoracoscopy findings, HPE reports, and post-procedure complications were recorded and analyzed using analysis of variance and chi-square test. The study comprised 62 patients with a mean age of 52 years at presentation. HPE of MT-guided biopsy confirmed tuberculosis in 22 (35.3%), malignancy in 18 (29%) cases, and 22 (35.5%) cases had chronic nonspecific inflammation. The most commonly observed MT finding in malignancy was pleural nodules (14.70%), followed by thickened pleura (10.50%) and growth (2.10%). In tuberculosis, the most common MT finding was adhesions in all, followed by nodules (5.28%). We also diagnosed a case of pleural amoebiasis and ependymoma, which are rare. Macroscopic findings had a significant correlation with the final histopathologic diagnosis, with a diagnostic yield of 66.1%. Gross thoracoscopic findings correlate well with the histopathological diagnosis of pleural effusion etiology, with a correlation coefficient of 0.73. Pleural nodules were the most common finding in malignancy, while adhesions were common in benign pathology like tuberculosis. A good diagnostic yield underscores the utility of MT in undiagnosed exudative lymphocytic pleural effusions.
Shaheen MMAM, Shaaban AY, Mahmoud MI, et al. The diagnostic role of thoracoscope in undiagnosed pleural effusion: rigid versus flexible. Egyptian J Chest Dis Tuberc 2014;63:635-42.
DOI: https://doi.org/10.1016/j.ejcdt.2014.03.009
Soni A, Bansal V, Goel A. The role of thoracoscopy in diagnosis and treatment of pleural disease. WJOLS 2012;2005:4-15.
DOI: https://doi.org/10.5005/jp-journals-10007-1141
Rahman NM, Ali NJ, Brown G, et al. Local anaesthetic thoracoscopy: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65:54-60.
DOI: https://doi.org/10.1136/thx.2010.137018
Barreiro TJ, Katzman PJ. Malignant mesothelioma: a case presentation and review. J Am Osteopath Assoc 2006;106:699-704.
Haridas N, KP S, TP R, et al. Medical thoracoscopy vs closed pleural biopsy in pleural effusions: a randomized controlled study. J Clin Diagn Res 2014;8:MC01-4.
DOI: https://doi.org/10.7860/JCDR/2014/7476.4310
Chen RL, Zhang YQ, Wang J, et al. Diagnostic value of medical thoracoscopy for undiagnosed pleural effusions. Exp Ther Med 2018;16:4590-4
DOI: https://doi.org/10.3892/etm.2018.6742
Law WL, Chan J, Lee S, et al. Pleuroscopy: our initial experience in Hong Kong. Hong Kong Med J 2008;14:178-84.
Mootha VK, Agarwal R, Singh N, et al. Medical thoracoscopy for undiagnosed pleural effusions: experience from a tertiary care hospital in North India. Indian J Chest Dis Allied Sci 2011;53:21-4.
DOI: https://doi.org/10.5005/ijcdas-53-1-21
Thangakunam B, Christopher DJ, James P, Gupta R. Semi-rigid thoracoscopy: initial experience from a tertiary care hospital. Indian J Chest Dis Allied Sci 2010;52:25-7.
DOI: https://doi.org/10.5005/ijcdas-52-1-25
Yang Y, Wu YB, Wang Z, et al. Long-term outcome of patients with nonspecific pleurisy at medical thoracoscopy. Respir Med 2017;124:1-5.
DOI: https://doi.org/10.1016/j.rmed.2017.01.005
Yu YX, Yang Y, Wu YB, et al. An update of the long-term outcome of patients with nonspecific pleurisy at medical thoracoscopy. BMC Pulm Med 2021;21:226.
DOI: https://doi.org/10.1186/s12890-021-01596-2
Khan MA, Ambalavanan S, Thomson D, et al. A comparison of the diagnostic yield of rigid and semirigid thoracoscopes. J Bronchology Interv Pulmonol 2012;19:98-101.
DOI: https://doi.org/10.1097/LBR.0b013e31824ee45b
Dhooria S, Singh N, Aggarwal AN, et al. A randomized trial comparing the diagnostic yield of rigid and semirigid thoracoscopy in undiagnosed pleural effusions. Respir Care 2014;59:756-64.
DOI: https://doi.org/10.4187/respcare.02738
Pathak H, Pandey S, Dave L, et al. To correlate clinical and biochemical profile of pleural effusion: a retrospective study in tertiary care centre of central India. Indian J Tuberc 2024;71:405-9.
DOI: https://doi.org/10.1016/j.ijtb.2023.07.006
Castro DJ, Nuevo GD, Pérez-Rodríguez E, Light RW. Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions. Eur Respir J 2003;21:220-4.
DOI: https://doi.org/10.1183/09031936.03.00051603
Kim SB, Shin B, Lee JH, et al. Pleural fluid ADA activity in tuberculous pleurisy can be low in elderly, critically ill patients with multi-organ failure. BMC Pulm Med 2020;20:13.
DOI: https://doi.org/10.1186/s12890-020-1049-6
Gioia M, Arancibia RL. A review of medical thoracoscopy and its role in management of malignant pleural effusion. J Respir 2024;4:35-49.
DOI: https://doi.org/10.3390/jor4010004
Shrestha BK, Adhikari S, Thakur BK, et al. Medical thoracoscopy for undiagnosed exudative pleural effusion: experience from two tertiary care hospitals of Nepal. JNMA J Nepal Med Assoc 2020;58:158-64.
DOI: https://doi.org/10.31729/jnma.4873
Zakaria A, Al-Share B, Al Asad K. Primary pulmonary amebiasis complicated with multicystic empyema. Case Rep Pulmonol 2016:2016:8709347.
DOI: https://doi.org/10.1155/2016/8709347
Swarnakar, Rajesh, Vaghani B, Dhoble C. Gr upSM to study the diagnostic yield of medical thoracoscopy in patients with pleural effusion of undetermined etiology. 2017.
Prabhu VG, Narasimhan R. The role of pleuroscopy in undiagnosed exudative pleural effusion. Lung India 2012;29:128-30.
DOI: https://doi.org/10.4103/0970-2113.95304
Soe Z, Aung Z, Darli Tun K. A clinical study on malignant pleural effusion. Int J Collab Res Intern Med Public Health 2012;4:761-79.
Patil CB, Dixit R, Gupta R, et al. Thoracoscopic evaluation of 129 cases having undiagnosed exudative pleural effusions. Lung India 2016;33:502-6.
DOI: https://doi.org/10.4103/0970-2113.188969
Kapadia V, Jindal S, Patel P, Tripathi S. A study of role of medical thoracoscopy in undiagnosed pleural effusion. J Assoc Physicians India 2023;71:11-2.
DOI: https://doi.org/10.5005/japi-11001-0172
Arif M, Bhargava R, Shameem M, et al. Diagnostic yield of medical thoracoscopy in undiagnosed exudative pleural effusion- a tertiary centre experience from Aligarh Muslim University, Uttar Pradesh, India. J Clin Diagn Res 2020;14:OC16-20.
DOI: https://doi.org/10.7860/JCDR/2020/44095.13990
Rawat J, Kumar A, Mrigpuri P, et al. Role of single port rigid thoracoscopy in undiagnosed pleural effusion. Tuberc Respir Dis 2024;87:194-9.
DOI: https://doi.org/10.4046/trd.2023.0102
Yousef AERI, Morsi AF, El-Shabrawy M, El Shahaat HA. The role of medical thoracoscopy in the diagnosis of exudative pleural effusion at the Chest Department of Zagazig University Hospitals. Egypt J Bronchol 2016;10:225-31.
DOI: https://doi.org/10.4103/1687-8426.193643
Helala LA, El-Assal GM, Farghally AA, El Rady MMA. Diagnostic yield of medical thoracoscopy in cases of undiagnosed pleural effusion in Kobri El-Kobba Military Hospital. Egyptian J Chest Dis Tuberc 2014;63:629-34.
DOI: https://doi.org/10.1016/j.ejcdt.2014.04.002
Wang Z, Tong ZH, Li HJ, et al. Semi-rigid thoracoscopy for undiagnosed exudative pleural effusions: a comparative study. Chin Med J 2008;121:1384-9.
DOI: https://doi.org/10.1097/00029330-200808010-00010
Marwah V, Bhattacharyya D, Mohamed Ali F, et al. Diagnostic utility of medical thoracoscopy in undiagnosed exudative pleural effusions. Med J Dr DY Patil University 2020;13:525-8.
DOI: https://doi.org/10.4103/mjdrdypu.mjdrdypu_277_19
Ranganatha R, Tousheed SZ, MuraliMohan BV, et al. Role of medical thoracoscopy in the treatment of complicated parapneumonic effusions. Lung India 2021;38:149-53.
DOI: https://doi.org/10.4103/lungindia.lungindia_543_20
Ethics Approval
The study was approved by the Institutional Ethics Committee of SDS Tuberculosis Research Centre & Rajiv Gandhi Institute of Chest Diseases as per the letter SDS/PG/01/2023-24 dated 21/2/2024.How to Cite
Naik G, Pradeep, Swathi Karanth MP, Aravind Ram, Akshata JS, Raghu BP, and Nagaraja C. 2025. “The Role of Medical Thoracoscopy in the Diagnosis of Exudative Lymphocytic Pleural Effusions: An Observational Study”. Monaldi Archives for Chest Disease, March. https://doi.org/10.4081/monaldi.2025.3233.
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