Abstract
Introduction: In a patient with suspected malignant pleural effusion and negative pleural fluid cytology, medical thoracoscopy is the next diagnostic step. Confirming the diagnosis of malignant disease involving the pleura usually means incurable cancer.
Talc poudrage during the diagnostic thoracoscopy would be a reasonable approach to gain efficient pleurodesis and to reduce patient discomfort due to repeat thoracocenteses that would be necessary in the case of recurrent pleural effusion.
However, in most institutions instantaneous section histology is not available. Thus, a visual diagnosis of malignant pleural disease would be desirable. The aim of our study was to find out if it is possible to differentiate between benign and malignant pleural disease simply by evaluating pleural nodularity.
Results: Between 11/2006 and 10/2007 we performed 81 medical thoracoscopies. 41 patients had a benign disease of the pleura and 40 had a malignant disease of the pleura. Pleural nodularity was noted in one benign case (a singular node) and in 29 malignant cases (four with a singular node, eleven with some nodes, and 14 with many nodes). Sensitivity for malignancy with the visibility of nodules was 72,5% and specificity was 97,6%. The positive predictive value for malignancy with one visible node was 80% and with some or many nodes 100%.
Conclusions: Nodularity is a strong predictor of pleural malignancy. If some or many nodes are visible during medical thoracoscopy, immediate talc pleurodesis is justified. However, in about one quarter of the cases of pleural malignancy, no nodularity was noted and for these cases immediate talc poudrage cannot be recommendated.
- © 2011 ERS