Thoracoscopy for the diagnosis of pleural disease

Ann Intern Med. 1991 Feb 15;114(4):271-6. doi: 10.7326/0003-4819-114-4-271.


Objective: To assess the accuracy and safety of thoracoscopy for the evaluation of pleural disease.

Design: Prospective evaluation of patients referred for thoracoscopy.

Setting: University hospital specializing in chest diseases.

Patients: We studied 102 patients with pleural disease, the cause of which had not been determined after initial investigation, including thoracentesis and needle biopsy. Eighty-six patients had pleural effusion, 11 had pleural mass, and 5 had pleural effusion in association with a known primary lung carcinoma.

Intervention: All patients had thoracoscopy under local anesthesia with mild sedation. Visually directed biopsies were done of parietal pleura.

Measurements: We recorded clinical characteristics, laboratory data, findings and duration of thoracoscopy, and any complications associated with the procedure. Hospital and clinic follow-up records were reviewed, and patients were contacted by telephone 12 and 24 months after thoracoscopy to assess their health status.

Main results: One hundred and four thoracoscopies were done in 102 patients. A definitive diagnosis was established in 95 patients: 42 had malignant pleural disease and 53 had benign pleural disease. A diagnosis of benign pleural disease using thoracoscopy could not be confirmed in the remaining 7 patients because of insufficient follow-up information. Overall, thoracoscopy was 96% accurate with a sensitivity of 91%, a specificity of 100% and a negative predictive value of 93% for the diagnosis of pleural malignancy. Thoracoscopy was well tolerated under local anesthesia and entailed hospitalization for less than 24 hours in most cases. No deaths occurred, although 1.9% of patients had major complications, and 5.5% had minor complications.

Conclusions: Among patients with pleural disease remaining undiagnosed after usual initial investigation, thoracoscopy done under local anesthesia is a rapid, safe, and well-tolerated procedure with an excellent diagnostic yield that is equivalent to that of thoracotomy.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Chi-Square Distribution
  • Evaluation Studies as Topic
  • False Negative Reactions
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Pleural Diseases / diagnosis*
  • Pleural Neoplasms / diagnosis
  • Predictive Value of Tests
  • Prospective Studies
  • Thoracoscopy* / adverse effects