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Diagnostic Value of Medical Thoracoscopy- A Retrospective Analysis
Correspondence Address :
Dr. Binu Krishnan,
Senior Consultant Pulmonologist, Trivandrum, Kerala, India.
E-mail: binukrishnanck@hotmail.com
Introduction: Clinical and radiological parameters might not be sufficient to diagnose the aetiology of exudative pleural effusions accurately. Often, thoracoscopy serve as an important added tool in the correct diagnosis.
Aim: To analyse the diagnostic accuracy of initial diagnosis (clinical and radiological) compared with thoracoscopic biopsy.
Materials and Methods: This was the retrospective study done on all the consecutive medical thoracoscopic procedures conducted in tertiary care centre (pulmonology wing), Trivandrum, India from May 2010 to April 2016. All thoracoscopic procedures were conducted in adult patients above the age of 18 years. Kappa statistics was performed to find the diagnostic accuracy.
Results: During this period, 94 diagnostic medical thoracoscopic procedures were performed. Majority of them were males (68.1%) and mean age was 54.8±13.53 years. Main diagnostic indications were undiagnosed exudative effusions (85.4%) and emphysema (7.1%). Tuberculosis was the most common initial diagnosis prior to the procedure (70.2%). Histopathology reports showed tuberculosis as the most common final diagnosis (45.7%), followed by malignancy (38%) and chronic inflammation (6.4%). Four patients who were not biopsied were excluded from diagnostic accuracy analysis. When thoracoscopic biopsy was taken as the gold standard, sensitivity was found to be 67.4% for initial diagnosis of tuberculosis and only 13.9% for malignancy. But specificity was found to be more for malignancy (81.5%) than tuberculosis (27.7%). Overall diagnostic accuracy of initial diagnosis was found to be 46.7% for tuberculosis and 54.4% for malignancy. There was minimal or no correlation (R=-0.173) between the diagnostic outcome and type of anaesthesia (local or general anaesthesia). There was no significant difference in occurrence of complications between local and general anaesthesia (p-value=0.717).
Conclusion: Medical thoracoscopy had an important additional diagnostic value in management of pleural diseases as evidenced by slight agreement between initial and final diagnosis
Malignancy, Pleural effusion, Pneumothorax, Tuberculosis
10.7860/JCDR/2021/49654.15717
Date of Submission: Mar 28, 2021
Date of Peer Review: Jul 09, 2021
Date of Acceptance: Oct 16, 2021
Date of Publishing: Dec 01, 2021
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No
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• iThenticate Software: Oct 21, 2021 (11%)
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