TY - JOUR T1 - Medical thoracoscopy – A district general hospital experience JF - European Respiratory Journal JO - Eur Respir J VL - 38 IS - Suppl 55 SP - p596 AU - Nanu Acharya AU - Richard Budd AU - Muhammad Malik Y1 - 2011/09/01 UR - http://erj.ersjournals.com/content/38/Suppl_55/p596.abstract N2 - The 2010 British Thoracic Society (BTS) guideline recommends the use of Medical Thoracoscopy (MT) in the management algorithm for malignant pleural effusion [1]. Despite this MT is not readily available outside of tertiary centres in the United Kingdom [1]. An internal audit in 2010 showed the burden of pleural effusion at Barnsley Hospital (BH) over an 18 month period led to 1195 medical admissions; 226 (18.9%) were malignant effusions.The diagnostic process for exudative pleural effusions has altered recently in BH to include semi-rigid MT.Method: A retrospective analysis of computed tomography (CT) reports, histology and length of stay (LOS) for all individuals who underwent diagnostic MT (dMT) was performed.Results: 44 MTs have been done to date. 32 were diagnostic and 12 therapeutic. Diagnostic MT results are as follows:Adenocarcinoma of Lung 10, Mesothelioma 2, Breast Carcinoma 3, Ovarian Carcinoma 1, Tuberculosis (TB) 2, Inflammatory Tissue 14.CT reports prior to dMT revealed a low suspicion of malignancy in 18 and a high suspicion of malignancy in 14.dMT histology confirmed malignancy in 14 patients within the high suspicion group. Within the low suspicion group dMT histology confirmed 2 cases of lung cancer, 2 cases of TB and no evidence of malignancy in 14.Average LOS after all MT was 3.7 days (range 1-11). The average LOS prior to the introduction of MT was 7.3 days (range 1-59).Conclusion: MT is cost-effective through reducing LOS and referral rates to tertiary centres. Additionally this study has highlighted a potential missed or delayed diagnosis in 12.5% of cases. Patient experience is improved by facilitating a timely patient journey within their local hospital.Reference:1. BTS Pleural Disease Guidelines 2010 ER -