Pleuroscopy for the Diagnosis of Cancer in Patients with Pleural Effusion: A Review of the Diagnostic Accuracy, Safety, Cost-Effectiveness and Guidelines

Key Message

One systematic review pooled estimates for diagnostic accuracy and found that semi-rigid thoracoscopy had high sensitivity and specificity for diagnosing pleural effusions of unknown etiology. One non-randomized retrospective study observed a high sensitivity and specificity for rigid thoracoscopy for the diagnosis of tuberculous pleural effusion.  Similarly, non-randomized retrospective and prospective studies found a high sensitivity and specificity for rigid or semi-rigid thoracoscopy for the diagnosis of malignant pleural effusion or malignancy. One non-randomized retrospective study reported no statistical difference in diagnostic accuracy between semi-rigid thoracoscopy compared with video-assisted thoracoscopic surgery in the assessment of pleural effusions that were malignant, suspicious for malignancy, or granulomatous inflammation combined.

An economic evaluation reported the mean procedure-related cost of semi-rigid thoracoscopy as $2,815 Canadian dollars (95% Confidence Interval $2,010 to $3,620) compared to video-assisted thoracoscopic surgery of $7,962 Canadian dollars (95% Confidence Interval $7,134 to $8,790) in patients with undiagnosed pleural effusions. Since all video-assisted thoracoscopic surgery was conducted in the hospital whereas 68% of semi-rigid thoracoscopy was performed as outpatient procedures, the longer hospital stay associated with video-assisted thoracoscopic surgery may have contributed to some of the difference in procedure cost.

Among the systematic reviews, randomized, and non-randomized retrospective and prospective studies, few significant procedural complications occurred among patients with undiagnosed pleural effusions that received medical thoracoscopy (pleuroscopy).

One evidence-based guideline suggests that medical thoracoscopy is well tolerated among patients with undiagnosed pleural effusions and exhibits a higher likelihood of diagnosis and pleurodesis in comparison to video-assisted thoracoscopic surgery as patients may have comorbidities and not tolerate general anesthesia.