Diagnostic Value of Flexible Thoracoscopy in Undiagnosed cases of Exudative Pleural Effusion

INTRODUCTION: Accurate diagnosis of pleural effusion is always a challenge for the pulmonologist. It often needs histological analysis. Gold standard method for the diagnosis of undiagnosed pleural effusion is by thoracoscopic means. Medical thoracoscopy is minimally invasive procedure done in conscious sedation whereas VATS is done under general anaesthesia. The major indication for Medical Thoracoscopy is evaluation of exudate pleural effusion which remains undiagnosed after pleural fluid analysis. With thoracoscopy we can visualise the visceral and parietal pleura and take pleural biopsy from suspicious areas under vision. AIM OF THE STUDY: To ascertain the diagnostic value of flexible thoracoscopy in undiagnosed exudative pleural effusion. METHODOLOGY: This is a prospective study conducted at Govt. Hospital of Thoracic Medicine, Tambaram, Chennai between October 2015 – July 2016.Those cases which failed to achieve diagnosis by initial pleural fluid analysis and pleural fluid cytology for malignancy negative undergone thoracoscopy. RESULTS: 1. Out of 40, 30 were males and 10 were females. 2. 11 cases was diagnosed as malignancy, of which 5 cases were metastatic malignancy, 4 adenocarcinoma, 2 metastatic renal cell carcinoma, 1metastatic carcinoma with primary bone, 1 metastatic deposits primary GI tract, 1 small cell carcinoma, 1pleural lymphoma and 1 poorly differentiated carcinoma lung. 3. Out of 29 nonmalignant cases, 18 cases were diagnosed as tuberculosis. Others came as chronic nonspecific inflammation, acute inflammatory process and chronic pleural fibrosis 4. 76.9% of haemorrhagic effusion came as malignancy, that is out of 13, 10 came out as malignancy. Of the 27 straw coloured effusion 2 came out as malignancy. The study is significant with 'p' value of 0.001 5. During thoracoscopy adhesions are found in 13 cases, nodules were found in 12 cases, normal pleura in 11 cases and mass lesion in 4 cases. 6. All cases with adhesions came as nonmalignant. 58.3% of the nodules came as malignancy. 90.9% of the normal pleura findings are seen in nonmalignant cases. 75% of the mass lesion came as malignancy. All these finding were significant with a 'p' value of 0.001. 7. So the overall yield of thoracoscopy in the diagnosis of TB and malignancy is 72.5%. None of the cases developed any complication. CONCLUSION: Medical thoracoscopy is a valuable tool in the diagnosis of undiagnosed exudative pleural effusion. It is a simple and safe method with high diagnostic yield