Diagnostic value of medical thoracoscopy for improvement diagnosis accuracy in pleural effusion

Objective To evaluate the efficacy and safety of medical thoracoscopy and the appropriate time for medical thoracoscopy.Methods A total of 311 patients with excudative pleural effusion were enrolled,male 194,female 117,aged 17-90 years old,mean age 58.3 years old.The diagnosis rate of cytological examinations of pleural effusion was evaluated.Twenty-seven patients whose diagnosis were not obtained by thoracocentesis and cellular examinations,and 2 cases of malignant pleural effusion without pathologically determined diagnosis received medical thoracoscopy.The combination of medical thoracoscopy and the method of thoracocentesis and cellular examinations were compared.Results Among the 311 patients,80 cases were diagnosed as malignant pleural effusion;the other 231 cases had not diagnosed by cytological examinations,but finally confirmed by the methods of individual conditions,medical thoracoscopy and/or bronchoscopy,pulmonary artery CT scan and clinical information.The diagnosis of 231 cases were as follows: 106 cases of malignant pleural effusion,91 cases of benign pleural effusion,34 cases were undetermined.The positive diagnosis rate of pleural effusion by cytological examinations only was 28.9 %(80/277).Among twenty-nine cases received medical thoracoscopy,25 cases got the definite diagnosis with positive diagnosis rate as 86.2 %.The total positive diagnosis rate was improved by the combination of medical thoracoscopy and the method of thoracocentesis and cellular examinations by 37.9 %(105/277),which was significantly higher than that of simple cellular examination(P = 0.024).The diagnosis rate was not improved in pleural effusion cytology of more than 3 times than 2 times,but the expense was higher than that of medical thoracoscopy.Conclusion It is demonstrated that medical thoracoscopy is a safe and effective method to diagnose the pleural effusion of unknown origin with relative high positive diagnostic rate.When twice thoracentesis and cytological examinations have not produced positive diagnosis,medical thoracoscopy should be performed if there is no contraindications exist.