Pleural biopsy and talc pleurodesis in undiagnosed recurrent pleural effusions: Many trades which one to choose?

Abstract

Introduction: Undiagnosed recurrent pleural effusions have always been an area of diagnostic burden & have posed hurdles in patient management.

Aim: To compare three different approaches in the diagnosis & management of undiagnosed recurrent pleural effusions;VATS with double lumen and general anaesthetic (GA) vs VATS with LMA (laryngeal mask) vs medical thoracoscopy(MT)with conscious sedation.

Materials/Methods: Retrospective review of cases performed in 3 big teaching hospitals between 2004-2014. Collection of epidemiological and clinical data re:diagnostic accuracy,length of stay,recurrence, symptoms.

Results: 90 patients with initially undiagnosed recurrent pleural effusions were identified through patient records; 53 males, 37 females, mean age 58 years(+/-24 years). All were referred for pleural biopsy & talc pleurodesis; 30 had VATS biopsy with double lumen tube under GA(A), 30 had VATS with LMA(B) & 30 had MT with conscious sedation (C). Diagnostic accuracy was similar in all groups respectively: 95%, 95%% & 93%. Mean hospital stay was respectively 3.3 days, 2.2 days, 1.5 days. Recurrence was observed in ∼4% of all cases. Mean score for chest pain 24h post procedure was 6/10 for group A, 4/10 for group B and 1/10 for group C while for dyspnoea were 7/10, 5/10, 2.5/10.

Conclusions: MT with conscious sedation seems to be a better tolerated & equally efficient in pleural biopsies & talc pleurodesis in undiagnosed recurrent pleural effusions in comparison with VATS (GA/LMA). VATS with LMA has less hospital stay & better resolution of symptoms post procedure as opposed to VATS with GA. Further randomised controlled trials are required to confirm the above findings.