OPA10 DIAGNOSTIC VALUE AND SAFETY OF MEDICAL THORACOSCOPY FOR MALIGNANT PLEURAL EFFUSION

See Qing Ang1, Nai- Chien Huan1, Larry Ellee Nyanti1 2, Subramaniam Ponnuvelu1, Shan Min Lo1, Hema Yamini Ramarmuty1 , Kunji Kannan Sivaraman Kannan1
1 Department of Respiratory Medicine, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia.
2 Medical Department, Faculty of Medicine and Health Sciences, University Malaysia Sabah, Kota Kinabalu, Malaysia.

Background

Medical thoracoscopy (MT) is an indispensable tool for patients with unexplained pleural effusions (PE). The diagnostic yield of pleural fluid cytology is only approximately 60%. This study aimed to assess the efficacy and safety of diagnosing malignant pleural effusion (MPE) with MT.

Method

Consecutive patients from Queen Elizabeth Hospital, Sabah who had undergone MT from August 2022 to May 2024 for unexplained exudative PEs were retrospectively reviewed; and their demographic, radiographic, and histological data were collected.

Results

211 cases were diagnostic out of a total of 227 cases conducted, giving an overall diagnostic yield of 93.0%. 73(35.0%, 43 males, mean age 59) had MPE. Other diagnoses in descending order were: 94(44.5%) tuberculous pleural effusion, 40(19.0%) parapneumonic effusion, and 4(1.9%) uraemic effusion. Semi-rigid MT (LTF-160, Olympus Medical, Japan) were used in all cases. 12(5.3%) cases were done as dry MT using a Veress needle (26120JL, Karl Storz, Germany) for artificial pneumothorax induction. Among patients with MPE, the most frequently encountered histology is lung adenocarcinoma (60 cases, 82.2%), followed by small cell lung carcinoma (5 cases, 6.8%) and squamous lung carcinoma (2 cases, 2.7%). 6 cases (8.2%) were of non-lung in origin; respective primaries include breast, gastric, colon, sarcoma and 2 patients with B-cell lymphoma. 30(41.1%) patients with lung adenocarcinoma harbour EGFR mutation; another 3(4.1%) had ALK mutations. 2(0.9%) patients developed significant complications: 1 significant bleeding post-biopsy requiring blood transfusion and 1 re-expansion pulmonary oedema requiring mechanical ventilation. Both received a final diagnosis of tuberculous pleural effusion.

Conclusions

MT is a safe and effective way of diagnosing MPE with the assistance of histopathology interpretation. It brings a high diagnostic yield for patients with unexplained exudative PE from initial thoracentesis.