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Mesothelioma
Treatment
Abstracts
& Articles
Medical
thoracoscopy in the diagnosis of
unexplained pleural effusion.
Respirology
1998 Jun;3(2):77-80
Wilsher
ML, Veale AG
Respiratory
Services, Green Lane Hospital, Auckland,
New Zealand.
Approximately
20% of pleural effusions remain without an
established aetiology after evaluation.
Thoracoscopy has a very high sensitivity
for the diagnosis of both benign and
malignant diseases and greatly increases
the diagnostic yield for pleural effusion.
We sought to evaluate the diagnostic yield
and safety of medical thoracoscopy at this
institution. The records of all patients
undergoing medical thoracoscopy for the
evaluation of undiagnosed pleural effusion
between 1990 and 1996 were reviewed. The
procedure was performed under local
anaesthesia with sedation using a Stortz
rigid thoracoscope. Fifty-eight patients
had thoracoscopy, most having had two
(range: 1-6) non-diagnostic pleural
aspirations and biopsies of the pleura.
Nineteen patients were found to have
mesothelioma and nine metastatic
malignancy. Three patients were considered
likely to have tuberculous pleural
disease, six had asbestos related benign
pleural fibrosis and three post-cardiotomy
syndrome. There was one chylous effusion
of uncertain aetiology, one posttraumatic
and two other benign effusions, both of
which resolved without clear aetiology. On
seven occasions the pleural space could
not be adequately accessed, but none of
these patients had prior computerized
tomography (CT) or ultrasound of the
pleural space. There were five false
negative diagnoses of malignancy, but no
false positives. The diagnostic
sensitivity for pleural malignancy was 85%
and specificity 100%. There were no major
complications, but four patients had late
tumour seeding at the thoracoscopy site.
Medical thoracoscopy is a safe procedure
with a high diagnostic yield.
Pre-operative evaluation of the pleural
collection using ultrasound or CT
increases the likelihood of successful
access to the pleural space and may
increase diagnostic yield.
PMID:
9692513, UI: 98355241
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