Abstract
Introduction Rising incidence of pleural disease has led to a growing need to provide readily accessible thoracoscopy services. Local anaesthetic thoracoscopy (LAT) is the investigation of choice for cytology negative exudative effusions where malignancy is suspected [1]. We report our experience in a district general hospital.
Methods We performed a retrospective audit of 138 patients having LAT at Poole NHS Foundation Trust (catchment area of 250,000) between November 2007 and April 2015.
Results 69% of the patients were male, median age being 80yrs (55–97). The main indication for LAT was suspected malignancy (89%). 68% of cases were locally referred, with the remainder from neighbouring trusts. Diagnoses included malignant mesothelioma (39%), chronic inflammation/infection (31%), lung cancer (7%) and breast cancer (6%). Our diagnostic yield from cytology was 60% in keeping with the national average. Histological confirmation by LAT was 98% sensitive with a 100% negative predictive value. 100% of normal macroscopic pleural appearances were found to be non-malignant. 72% had talc poudrage with an 84% success rate at 30 days. Complications included pleural infection (n=1(0.7%)), death within 30 days (n=1(0.7%)) and surgical emphysema (n=3(2.0%)). Median length of stay was 2.0 days compared with the national average of 4.6 days [1].
Conclusion LAT can be provided by a DGH as a safe and effective procedure with minimal length of stay and a high diagnostic yield. Normal macroscopic pleural appearance is a sensitive marker of absence of malignancy.
References 1. BTS Pleural Disease Guideline 2010: BTS Guidelines for the Management of Pleural Disease. Thorax 2003 May; 58(Suppl 2): 1–59.
- Copyright ©the authors 2016
