RESUMEN
The procedure of medical thoracoscopy provides a window into the pleural space to perform biopsy under direct visualization, particularly when thoracocentesis and closed pleural biopsy are inconclusive. The development of the semirigid thoracoscope, which is handled similarly to a bronchoscope, has made this procedure feasible and successful by most pulmonologists. It remains unknown whether certain pleural lesions, as visualized on thoracoscopy, has potential diagnostic value. We aimed to assess diagnostic value of the semirigid thoracoscope and correlate endoscopic finding with the histological diagnosis. From January 2010 to January 2012, 64 diagnostic medical thoracoscopies were performed to 64 patients with undiagnosed pleural effusion, in a tertiary care university hospital. All patients had thoracoscopy with visually directed biopsies and pleural lesion rating under local anaesthesia and mild sedation. Endoscopic findings were classified as: pleural thickening, nodules, adhesions and whitish lymphedema. The yield of the thoracoscopic biopsy in reaching final diagnosis was [98.4%]. Thoracoscopic diagnosis of malignancy in our study was [76.6%] whereas benign diagnosis was [23.4%]. Thoracoscopy was well tolerated under local anaesthesia and in most cases it was a one day procedure. Significant relations were found between endoscopic and pathology findings. Presence of nodules and lymphedema had a trend a positive relation with malignancy, p-value [0.002] and [0.009] respectively. Medical thoracoscopy is a simple relatively low-cost procedure. In the hands of experienced physicians it is generally safe, and highly effective at achieving a histological diagnosis. The presence of nodules and lymphedema, carries a high possibility of the effusion to be of a malignant etiology