PURPOSE: To determine if number of thoracenteses performed prior to thoracoscopy reflects pleurodesis success rates
METHODS: We performed a retrospective chart review of patients with a diagnosis of malignant pleural effusion that underwent medical thoracoscopy from March 2007 to March 2011. The patients were divided into two groups based on the success of pleurodesis. Patients who did not have talc pleurodesis or tunneled pleural catheter placement at the time of thoracoscopy were excluded. Demographic data, number of thoracentesis, primary malignancy, positive pleural fluid cytology and whether pleurodesis was achieved were analyzed.
RESULTS: 63 patients underwent medical thoracoscopy, of which 35 were diagnosed with malignant pleural effusion.11 patients had diagnostic thoracoscopy only. The remaining 24 underwent either talc pleurodesis or tunneled pleural catheter placement during the thoracoscopy. The average age was 63 ± 2.55. There were slightly more women than men (58 % vs. 42 %). Of the 24 patients 16 (67 %) achieved pleurodesis. The pleurodesis rates in patients who underwent talc pleurodesis and indwelling pleural catheter were 86 % (1 failure) and 61 % respectively. The mean number of thoracenteses performed prior to thoracoscopy was significantly higher in patients who failed pleurodesis (2.28 vs.1.44; p = 0.04). There was no statistically significant difference between the groups regarding age, sex, primary malignancy, positive pleural fluid cytology or type of intervention performed (talc pleurodesis or tunneled pleural catheter).
CONCLUSIONS: The number of thoracenteses performed was significantly higher in patients who failed pleurodesis.
CLINICAL IMPLICATIONS: In patients with malignant pleural effusion, the number of thoracenteses may inversely reflect success rates of pleurodesis whether this is due to delayed interventions or as a result of the thoracenteses remains to be determined.
DISCLOSURE: Kevin Kovitz: Consultant fee, speaker bureau, advisory committee, etc.: Dr.Kovitz is a consultant for Carefusion via employer.
The following authors have nothing to disclose: Neeraj Desai, Mary Vance, Sara Greenhill
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