Tuberc Respir Dis.  2007 Sep;63(3):261-267. 10.4046/trd.2007.63.3.261.

Diagnostic Accuracy and Safety of Medical Thoracoscopy

• Yang JK
• Lee JH
• Kwon MH
• Jeong JH
• Lee GE
• Cho HM
• Kim YJ
• Jung SM
• Choi EG
• Son JW
• Na MJ

• KMID: 1518417
• DOI: http://doi.org/10.4046/trd.2007.63.3.261

Abstract

BACKGROUND: The causes of the pleural effusion are remained unclear in a the substantial number of patients with exudative effusions determined by an examination of the fluid obtained via thoracentesis. Among the various tools for diagnosing exudative pleural effusions, thoracoscopy has a high diagnostic yield for cancer and tuberculosis. Medical thoracoscopy can also be carried out under local anesthesia with mild sedation. The aim of this study was to determine diagnostic accuracy and safety of medical thoracoscopy.
METHODS
Twenty-five patients with exudative pleural effusions of an unknown cause underwent medical thoracoscopy between October 2005 and September 2006 in Konyang University Hospital. The clinical data such as age, gender, preoperative pulmonary function, amounts of pleural effusion on lateral decubitus radiography were collected. The vital signs were recorded, and arterial blood gas analyses were performed five times during medical thoracoscopy in order to evaluate the cardiopulmonary status and acid-base changes.
RESULTS
The mean age of the patients was 56.8 years (range 22-79). The mean depth of the effusion on lateral decubitus radiography (LDR) was 27.49 mm. The medical thoracoscopic pleural biopsy was diagnostic in 24 patients (96.0%), with a diagnosis of tuberculosis pleurisy in 9 patients (36%), malignant effusions in 8 patients (32%), and parapneumonic effusions in 7 patients (28%). Medical thoracoscopy failed to confirm the cause of the pleural effusion in one patient, who was diagnosed with tuberculosis by a pericardial biopsy. There were no significant changes in blood pressure, heart rate, acid-base and no major complications in all cases during medical thoracoscopy (p>0.05).
CONCLUSIONS
Medical thoracoscopy is a safe method for patients with unknown pleural effusions with a relatively high diagnostic accuracy.

Keyword

Accuracy; Biopsy; Diagnosis; Medical thoracoscopy; Pleural effusion; Safety

MeSH Terms

Anesthesia, Local
Biopsy
Blood Gas Analysis
Blood Pressure
Diagnosis
Heart Rate
Humans
Pleural Effusion
Pleurisy
Radiography
Thoracoscopy*
Tuberculosis
Vital Signs

Figure

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  Figure 1 The instruments of 5 mm minithoracoscopy. Top. 5 mm trocar (WOLF Company, Knittlingen, Germany). 1.8 mm aspiration needile (WOLF Company, Knittlingen, Germany). 5 mm telescope (WOLF Company, Knittlingen, Germany). Endohook electrocautery (WOLF Company, Knittlingen, Germany) Bottom. 5 mm thoracoscopic grasping forcep. (Tyco-AutoSuture Tyco Healthcare, Gosport, UK)

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  Figure 2 The comparisons of 5 mm & 10 mm trocar and telescope. Top. 5 mm trocar (WOLF Company, Knittlingen, Germany ). 10 mm trocar (WOLF Company, Knittlingen, Germany). 5 mm telescope (WOLFCompany, Knittlingen, Germany) Bottom. 10 mm telescope (WOLF Company, Knittlingen, Germany)

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  Figure 3 Changes of PaO2, PaCO2 and MAP in patients aged below or above 65 years old through the process of medical thoracoscopy. All values were measured during supplement of 5 ml/min of oxygen via mask. PaO2: arterial oxygen tension; PaCO2: arterial carbon dioxide tension; MAP: mean arterial pressure.

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  Figure 4 Changes of PaO2, PaCO2 and MAP by sex differences through the process of medical thoracoscopy. All values were measured during supplement of 5 ml/min of oxygen via mask. PaO2: arterial oxygen tension PaCO2: arterial carbon dioxide tension MAP: mean arterial pressure.

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  Figure 5 Changes of PaO2, PaCO2 and MAP in patients with LDR below or above 27.4 mm through the process of medical thoracoscopy. All values were measured during supplement of 5 ml/min of oxygen via mask. PaO2: arterial oxygen tension PaCO2: arterial carbon dioxide tension MAP: mean arterial pressure LDR: depth of pleural effusion on lateral decubitus radiography.

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  Figure 6 Changes of PaO2, PaCO2 and MAP in patient with FEV1% below or above 50 through the process of medical thoracoscopy. All values were measured during supplement of 5 ml/min of oxygen via mask. PaO2 : arterial oxygen tension PaCO2 : arterial carbon dioxide tension MAP: mean arterial pressure.

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