Thoracoscopy for the diagnosis of pleural disease.
OBJECTIVE
To assess the accuracy and safety of thoracoscopy for the evaluation of pleural disease.


METHODS
Prospective evaluation of patients referred for thoracoscopy.


METHODS
University hospital specializing in chest diseases.


METHODS
We studied 102 patients with pleural disease, the cause of which had not been determined after initial investigation, including thoracentesis and needle biopsy. Eighty-six patients had pleural effusion, 11 had pleural mass, and 5 had pleural effusion in association with a known primary lung carcinoma.


METHODS
All patients had thoracoscopy under local anesthesia with mild sedation. Visually directed biopsies were done of parietal pleura.


METHODS
We recorded clinical characteristics, laboratory data, findings and duration of thoracoscopy, and any complications associated with the procedure. Hospital and clinic follow-up records were reviewed, and patients were contacted by telephone 12 and 24 months after thoracoscopy to assess their health status.


RESULTS
One hundred and four thoracoscopies were done in 102 patients. A definitive diagnosis was established in 95 patients: 42 had malignant pleural disease and 53 had benign pleural disease. A diagnosis of benign pleural disease using thoracoscopy could not be confirmed in the remaining 7 patients because of insufficient follow-up information. Overall, thoracoscopy was 96% accurate with a sensitivity of 91%, a specificity of 100% and a negative predictive value of 93% for the diagnosis of pleural malignancy. Thoracoscopy was well tolerated under local anesthesia and entailed hospitalization for less than 24 hours in most cases. No deaths occurred, although 1.9% of patients had major complications, and 5.5% had minor complications.


CONCLUSIONS
Among patients with pleural disease remaining undiagnosed after usual initial investigation, thoracoscopy done under local anesthesia is a rapid, safe, and well-tolerated procedure with an excellent diagnostic yield that is equivalent to that of thoracotomy.
Menzies
R
R
Montreal Chest Hospital, Quebec.
Charbonneau
M
M
D000368:Aged; D016009:Chi-Square Distribution; D005069:Evaluation Studies as Topic; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000175:diagnosis*; D010997:Pleural Neoplasms / Q000175:diagnosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013906:Thoracoscopy / Q000009:adverse effects