AB020. Thoracoscopy under local anesthesia, the 5-year experience of a single center

Background: This is a retrospective analysis of the histological reports and the diagnostic ability of thoracoscopy under local anesthesia (medical thoracoscopy) in a single center with 5-year experience (2011–2016).

Methods: We assessed the histological results of all thoracoscopies that were performed at the endoscopy suite of the respiratory system at General Hospital “G. Papanikolaou”, Thessaloniki, Greece. All patients suffered from undiagnosed exudative pleural effusion with at least two cytology tests negative for malignancy. The thoracoscopies were performed using the single-port method with a rigid thoracoscope 10 mm (HOPKINS Straight Forward Telescope 00, with angled eyepiece, diameter 10 mm, length 27 cm, with 6 mm working channel, KARL STORZ).

Results: A total of 133 thoracoscopies were performed during the study period (1/11/2011–5/10/2016). In seven cases no biopsy was taken (failure to enter the pleural cavity due to adhesions, refusal of the patient, respiratory arrest). The diagnoses that were set for the rest of cases (126 patients) were: lung adenocarcinoma (27 patients, 21%), mesothelioma (20 patients, 16%), other malignant pleurisy (18 patients, 14%) nonspecific chronic inflammatory pleurisy (54 patients, 43%), tuberculous pleurisy (4 patients, 3%) and para-malignant effusion (3 patients, 2%). The diagnosis of malignant pleurisy was made in a total of 63 patients (50%). In patients with other malignancies the distribution was: breast adenocarcinoma (3), adenocarcinoma of the gastrointestinal system (3), reproductive system adenocarcinoma (1), carcinoma of unknown primary site (4), other lung carcinomas (5, large cell: 2; neuroendocrine: 1; squamous: 1; small cell: 1), melanoma (1) and giant cell carcinoma (1). Three patients with nonspecific chronic inflammation were eventually diagnosed with a malignancy (in 2: lung adenocarcinoma on the basis of cytology test of fluid and in 1: mesothelioma on the basis of open biopsy).

Conclusions: Thoracoscopy under local anesthesia is a key diagnostic technique for patients with undiagnosed pleural effusion after the initial diagnostic algorithm. About half of the patients who underwent thoracoscopy were proved to suffer from malignant pleural effusion.

Keywords: Pleural effusion; thoracoscopy; local anesthesia