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Disorders of the Pleura |

The Diagnostic Role of Thoracoscope in Undiagnosed Pleural Effusion: Rigid vs Flexible

Mostafa Shaheen, MBBCh; Ahmad Shaaban, MBBCh; Mahmoud Mahmoud, MBBCh; Amal Shaaban, MBBCh; Rania Sweed, MBBCh
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Alexandria Main University Hospital, Alexandria, Egypt


Chest. 2014;146(4_MeetingAbstracts):436A. doi:10.1378/chest.1989958
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Abstract

SESSION TITLE: Pleural Disease Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: To evaluate the diagnostic role of medical thoracoscope in undiagnosed exudative pleural effusion & to compare the diagnostic yield of rigid versus flexible thoracoscopy.

METHODS: Forty patients with exudative pleural effusion of undetermined etiology were enrolled between July 2011 & October 2012. Each patient underwent both rigid and flexible thoracoscopy. Fiberoptic bronchoscope (FOB) was used as a flexible thoracoscope. Equal biopsies taken with both types were sent for histopathological & microbiological examination.

RESULTS: Both instruments were easy to handle. Excellent views were obtained by rigid thoracoscope, which were not that good using FOB whose flexibility made orientation & biopsy taking difficult. Rigid instrument specimens were larger (11mm versus 2.5mm). Histologically adequate samples were obtained in all patients using the rigid thoracoscope, whereas inadequate samples were obtained in 5 patients using FOB. Histopathology reports of rigid instrument specimens never included the terms “inadequate” or “suspicious” which were encountered in FOB reports. Histopathological features were identical in 25 patients; FOB was more informative in 2 patients, & rigid thoracoscope more informative in 13 patients. The term ‘fibrinous pleurisy’ as a histological diagnosis was more common in FOB reports (40% versus 32%). The diagnostic yeild of FOB & that of rigid thoracoscope was 80% (32/40) versus 95% (38/40), respectively. Combining results of both thoracoscopes, observing patients' clinical course & additional investigations enabled a definite final diagnosis in 39/40 patients (97.5%). Diagnoses were as follows; Malignant pleural effusions (MPE) in 45%,tuberculous (TB) effusions in 35%, co-existent TB pleurisy & MPE in 12.5%, complicated parapneumonic effusion and brucellosis in 2.5% each. Only 1 patient remained idiopathic. Among patients with MPE (14% mesothelioma & 86% metastatic pleural carcinoma), the most common histological subtype of metastatic pleural malignancy was adenocarcinoma (63%). Both lung & breast constituted the primary site in two thirds of patients with metastatic pleural disease.There were no major complications.

CONCLUSIONS: Thoracoscopy using either FOB or rigid thoracoscope is a safe procedure. Rigid thoracoscope has higher diagnostic yield, easier handling, better orientation.

CLINICAL IMPLICATIONS: Rigid thoracoscope is superior to FOB when used as a thoracoscope. Nevertheless, FOB is an alternative technique if rigid thoracoscopy is not available.

DISCLOSURE: The following authors have nothing to disclose: Mostafa Shaheen, Ahmad Shaaban, Mahmoud Mahmoud, Amal Shaaban, Rania Sweed

No Product/Research Disclosure Information


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