Diagnostic value of medical thoracoscopy in pleural disease: a 6-year retrospective study.
OBJECTIVE
Unlike thoracocentesis and closed pleural biopsy (CPB), medical thoracoscopy permits biopsy with direct visualization. In a 6-year retrospective study of patients having undergone at least one medical thoracoscopy, we analyzed the diagnostic yield of thoracoscopy and its value in the management of pleural disease.


METHODS
From January 1, 1989, to December 31, 1994, 168 medical thoracoscopies were performed on 154 patients (123 men; mean age +/- SE, 61 +/- 1 years), of which 149 were diagnostic and 19 were indicated for therapeutic assessment in malignant mesothelioma (MM). Prior to thoracoscopy, at least one CPB had been performed in 120 of 149 cases, yielding a diagnosis in 96 cases.


RESULTS
Thoracoscopy challenged the CPB-based diagnosis in 43 of 96 cases. In 66 cases of nonspecific inflammation diagnosed by CPB, thoracoscopy revealed MM in 16 cases, adenocarcinoma in 10 cases, undetermined carcinoma in 3 cases, and pleural tuberculosis in 3 cases. In 18 cases in which the CPB diagnosis was MM, thoracoscopy, performed for precise staging, challenged the diagnosis in 4 cases. In 12 cases of carcinoma diagnosed by CPB, thoracoscopy specified the histologic type in 7 cases. Thoracoscopic diagnoses were found to be erroneous in 10 of 149 cases, mainly owing to pleural adhesions that limited access to the pleural cavity. There was one thoracoscopy-related death, one case of sepsis, and six cases of empyema.


CONCLUSIONS
Medical thoracoscopy appears to be efficient and relatively safe in the management of pleural disease. Pleural adhesions can lower its diagnostic value.
Blanc
François-Xavier
FX
Service de Pneumologie et de Pathologie Professionnelle, Centre Hospitalier Intercommunal, Créteil, France.
Atassi
Kinan
K
Bignon
Jean
J
Housset
Bruno
B
D000230:Adenocarcinoma / Q000175:diagnosis; D001706:Biopsy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis; D008875:Middle Aged; D010994:Pleura / Q000473:pathology*; D010995:Pleural Diseases / Q000175:diagnosis; D010997:Pleural Neoplasms / Q000175:diagnosis*; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods; D014396:Tuberculosis, Pleural / Q000175:diagnosis