In situations of unexplained exudative pleural effusions, medical thoracoscopy (MT) is a well-established diagnostic method. However, despite the benefits of MT, problems exist since cancers may resemble pleural inflammation. For a study, researchers sought to determine the association between the macroscopic appearance of the pleura at MT, the histology of the pleural biopsy, and the ultimate diagnosis following follow-up.

Over 8 years, data were gathered prospectively on patients receiving MT using a standardized computerized thoracoscopy report. The sensitivity, specificity, positive and negative predictive values (PPV, NPV) of macroscopic alterations, the sensitivity of computer tomographic (CT) appearances, and the ultimate result are all reported. A total of 228 thoracoscopies and biopsies were done, with 70 reports describing benign macroscopic alterations and 15.7% having malignant histology. When the final result was considered, the sensitivity of macroscopic appearance at MT was 91.5%, the specificity was 76.0%, the PPV was 88.6%, and the NPV was 81.4%. Malignancy was more likely linked with nodular alterations (Chi2 75.5, P<0.05). Before thoracoscopy, CT scans had low sensitivity for detecting malignant pleural effusion (50%) but high specificity for diagnosing benign illness (90.5%).

A systematic, standardized report enabled the proper evaluation of macroscopic data at MT. The PPV of macroscopic signs for malignancy is rather good; nonetheless, despite benign-looking macroscopic alterations, the ultimate diagnosis was malignancy in a considerable proportion of instances. Therefore, in instances with benign histology, careful attention should be given to either surveillance or further diagnostic testing based on clinical suspicion.

Reference: resmedjournal.com/article/S0954-6111(22)00148-2/fulltext