Diagnostic Value And Safety of Medical Thoracoscopy In The Pleural Effusion of Different Causes

Abstract Background: Pleural effusions are caused by various reasons, whose diagnosis remains challenging in spite of various means of diagnosis. Medical thoracoscopy, greatly improves the diagnostic efficacy and gets preference for managements, especially undiagnosed pleural effusions. This study aimed to assess the diagnostic efficacy and safety of medical thoracoscopy in patients with pleural effusion of different causes. Methods: Between January 1st 2012 and April 30th 2021, patients with pleural effusion underwent medical thoracoscopy in the Department of Respiratory Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University. According to the discharge diagnosis, patients were grouped into three, including malignant, tuberculous and inflammatory group. General information, tuberculosis-related and effusion-related indices of three groups were analyzed. The diagnostic yield, diagnostic accuracy, performance under thoracoscopy and complications of patients were compared in three groups. Then, the significant factors for predictive diagnosis between the malignant and tuberculous group were analyzed. Results: During this 10-year study, 106 patients were included, with 67 males and 39 females, mean age 57.1±14.184 years. In 74 patients confirmed under thoracoscopy, 41 patients (38.7%) were malignant, 21 patients (19.8%) tuberculous and 32 patients (30.2%) undiagnostic. The diagnostic yield of medical thoracoscopy is 69.8%, and 75.9% in the malignant, 48.8% in the tuberculous, and 75.0% in the inflammatory. The diagnostic accuracies are 100%, 87.5%, and 75.0%, respectively. Under thoracoscopy, we observed single or multiple pleural nodules in 81.1%, pleural adhesions in 34.0% of patients with pleural effusions. The most common complication was chest pain (41.5%), following by chest tightness (11.3%), fever (10.4%). Multivariate logistic regression analysis showed that effusion appearance (OR=0.001, 95%CI: 0.000-0.204, P=0.010), CEA (OR=0.243, 95%CI: 0.081-0.728, P=0.011) were significant in the differentiation of malignant and tuberculous pleural effusion. Conclusion: Medical thoracoscopy is an effective, safe, less invasive procedure with high diagnostic yield for the pleural effusion of different causes. Medical thoracoscopy has a promising prospect.