Pleural Touch Preparations and Direct Visualization of the Pleura during Medical Thoracoscopy for the Diagnosis of Malignancy
Date
2017
Type:
Article
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Abstract
Rationale: During diagnostic thoracoscopy, talc pleurodesis
after biopsy is appropriate if the probability of malignancy is
sufficiently high. Findings on direct visual assessment of the pleura
during thoracoscopy, rapid onsite evaluation (ROSE) of touch
preparations (touch preps) of thoracoscopic biopsy specimens, and
preoperative imaging may help predict the likelihood of malignancy;
however, data on the performance of these methods are limited.
Objectives: To assess the performance of ROSE of touch preps,
direct visual assessment of the pleura during thoracoscopy, and
preoperative imaging in diagnosing malignancy.
Methods: Patients who underwent ROSE of touch preps during
thoracoscopy for suspected malignancy were retrospectively
reviewed. Malignancy was diagnosed on the basis of final pathologic
examination of pleural biopsy specimens. ROSE results were
categorized as malignant, benign, or atypical cells. Visual assessment
results were categorized as tumor studding present or absent.
Positron emission tomography (PET) and computed tomography
(CT) findings were categorized as abnormal or normal pleura.
Likelihood ratios were calculated for each category of test result.
Results: The study included 44 patients, 26 (59%) with a final
pathologic diagnosis of malignancy. Likelihood ratios were as
follows: for ROSE of touch preps: malignant, 1.97 (95% confidence
interval [CI], 0.90–4.34); atypical cells, 0.69 (95% CI, 0.21–2.27);
benign, 0.11 (95% CI, 0.01–0.93); for direct visual assessment: tumor
studding present, 3.63 (95% CI, 1.32–9.99); tumor studding absent,
0.24 (95% CI, 0.09–0.64); for PET: abnormal pleura, 9.39 (95% CI,
1.42–62); normal pleura, 0.24 (95% CI, 0.11–0.52); and for CT:
abnormal pleura, 13.15 (95% CI, 1.93–89.63); normal pleura,
0.28 (95% CI, 0.15–0.54).
Conclusions: A finding of no malignant cells on ROSE of
touch preps during thoracoscopy lowers the likelihood of
malignancy significantly, whereas finding of tumor studding
on direct visual assessment during thoracoscopy only
moderately increases the likelihood of malignancy. A positive
finding on PET and/or CT increases the likelihood of
malignancy significantly in a moderate-risk patient group
and can be used as an adjunct to predict malignancy before
pleurodesis.
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Citation
Grosu, H. B., Vial-Rodriguez, M., Vakil, E., Casal, R. F., Eapen, G. A., Morice, R., . . . Ost, D. E. (2017). Pleural Touch Preparations and Direct Visualization of the Pleura during Medical Thoracoscopy for the Diagnosis of Malignancy. Annals of the American Thoracic Society, 14(8), 1326-1331. https://doi.org/10.1513/AnnalsATS.201701-056OC
Keywords
Pleural effusion, Pleural biopsy, Medical thoracoscopy, Malignant pleural effusion