Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2022; 10(10): 3088-3100
Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3088
Diagnostic value and safety of medical thoracoscopy for pleural effusion of different causes
Xiao-Ting Liu, Xi-Lin Dong, Yu Zhang, Ping Fang, Hong-Yang Shi, Zong-Juan Ming
Xiao-Ting Liu, Yu Zhang, Ping Fang, Hong-Yang Shi, Zong-Juan Ming, Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
Xi-Lin Dong, Department of Respiratory, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
Author contributions: Dong XL conceived and designed the study; Liu XT and Zhang Y analyzed the data and collected the related clinical information; Liu XT drafted the manuscript; Fang P, Shi HY and Ming ZJ revised the manuscript critically for important intellectual content; All authors have read and approved the final manuscript.
Supported by Shaanxi Science and Technology Research Plan Program, Shaanxi, China, No. 2020SF-106.
Institutional review board statement: This study was approved by the Ethics Committee of The Second Affiliated Hospital of Xi'an Jiaotong University (No. 2021055).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xi-Lin Dong, PhD, Chief Doctor, Department of Respiratory, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an 710004, Shaanxi Province, China. dxl1103@163.com
Received: September 13, 2021
Peer-review started: September 13, 2021
First decision: January 18, 2022
Revised: January 31, 2022
Accepted: February 23, 2022
Article in press: February 23, 2022
Published online: April 6, 2022
Abstract
BACKGROUND

Pleural effusions occur for various reasons, and their diagnosis remains challenging despite the availability of different diagnostic modalities. Medical thoracoscopy (MT) can be used for both diagnostic and therapeutic purposes, especially in patients with undiagnosed pleural effusion.

AIM

To assess the diagnostic efficacy and safety of MT in patients with pleural effusion of different causes.

METHODS

Between January 1, 2012 and April 30, 2021, patients with pleural effusion underwent MT in the Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University (Shaanxi, China). According to the discharge diagnosis, patients were divided into malignant pleural effusion (MPE), tuberculous pleural effusion (TBPE), and inflammatory pleural effusion (IPE) groups. General information, and tuberculosis- and effusion-related indices of the three groups were analyzed. The diagnostic yield, diagnostic accuracy, performance under thoracoscopy, and complications of patients were compared among the three groups. Then, the significant predictive factors for diagnosis between the MPE and TBPE groups were analyzed.

RESULTS

Of the 106 patients enrolled in this 10-year study, 67 were male and 39 female, with mean age of 57.1 ± 14.184 years. Among the 74 thoracoscopy-confirmed patients, 41 (38.7%) had MPE, 21 had (19.8%) TBPE, and 32 (30.2%) were undiagnosed. Overall diagnostic yield of MT was 69.8% (MPE: 75.9%, TBPE: 48.8%, and IPE: 75.0%, with diagnostic accuracies of 100%, 87.5%, and 75.0%, respectively). Under thoracoscopy, single or multiple pleural nodules were observed in 81.1% and pleural adhesions in 34.0% with pleural effusions. The most common complication was chest pain (41.5%), followed by chest tightness (11.3%) and fever (10.4%). Multivariate logistic regression analyses showed effusion appearance [odds ratio (OR): 0.001, 95%CI: 0.000-0.204; P = 0.010] and carcinoembryonic antigen (OR: 0.243, 95%CI: 0.081-0.728; P = 0.011) as significant for differentiating MPE and TBPE, with area under the receiver operating characteristic curve of 0.977 (95%CI: 0.953-1.000; P < 0.001).

CONCLUSION

MT is an effective, safe, and minimally invasive procedure with high diagnostic yield for pleural effusion of different causes.

Keywords: Medical thoracoscopy, Pleural effusion, Diagnostic value, Safety, Thoracoscopic performance, Differential diagnosis

Core Tip: To evaluate the efficacy and safety of medical thoracoscopy (MT) for pleural effusion of different causes, this study retrospectively analyzed the medical records of 106 patients with pleural effusion who underwent MT at our hospital. The results showed that MT had high diagnostic value and a good safety profile, especially for malignant pleural effusion. Due to its clinical practicability, it is worth continually improving and vigorously promoting this technology.