ABSTRACT
A malignant pleural effusion is diagnosed by finding exfoliated malignant cells in pleural fluid or by demonstrating these cells in pleural tissues obtained by closed pleural biopsy, thoracoscopy, or thoracotomy. Precise diagnosis is mandatory as different tumors have different managements. Unlike thoracocentesis and closed pleural biopsy [CPB]; medical thoracoscopy [MT] permits biopsy with direct visualization of the pleural surfaces. The aim of this study was to evaluate of the role of MT in the diagnosis of pleural malignancies in 2 situations: the 1[st] situation; patients with exudative pleural effusion [EPE], in whom thoracocentesis and CPB have failed to establish a diagnosis [15 patients; group I], the 2[nd] situation; patients with EPE, in whom these procedures have established a diagnosis of pleural malignancies [15 patients; group II]. Among the 15 patients of group I; MT established a diagnosis in 14 patients [93%]. Malignancy was the main diagnosis detectable on thoracoscopy; 9 of 15 patients [60%] proved to have pleural malignancies; five patients [33%] proved to have non-malignant conditions after thoracoscopy, MT failed to establish the diagnosis in one patient [7%] [non-specific pleurisy]. Out of the 15 patients in group II, MT confirmed the diagnosis established by thoracocentesis and CPB in 12 cases [80%] and corrected the diagnosis in 3 cases [20%]; a malignant mesothelioma [MM] was corrected to adenocarcinoma, an adenocarcinoma was corrected to MM, and an adenocarcinoma was corrected to squamous cell carcinoma. Few minor complications were reported in five patients [16.7%] including empyema, residual pneumothorax, subcutaneous emphysema and tumor implantation at the site of MT. No bleeding or mortality was reported. In conclusion, MT under local anesthesia and conscious sedation is a safe procedure and could be applied to a variety of indications especially when a pleural malignancy is suspected. Moreover, MT asserts its usefulness in modifying the diagnosis of prior malignancy and to overcome the problem in the distinction between MM and adenocarcinoma thus saving the patients from unnecessary thoracotomy especially in inoperable cases