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THE LONG-TERM PROGNOSIS OF PATIENTS WITH THE DIAGNOSIS OF NONMALIGNANT PLEURAL EFFUSIONS AFTER PLEUROSCOPY

Lahey Clinic Medical Center, Burlington, MA

PURPOSE: Several studies have demonstrated the diagnostic yield of medical thoracoscopy (pleuroscopy) in making the diagnosis of malignant pleural effusion (MPE). No previous studies, however, have reported long-term outcomes for patients undergoing diagnostic pleuroscopy in whom no malignancy was demonstrated either with cytologic examination of pleural fluid or pathologic examination of thoracoscopic-guided pleural biopsies. We report the results of long-term follow-up (at least three years) of patients with the diagnosis of non-malignant pleural effusions after pleuroscopy.

METHODS: Pleuroscopy has been performed at the Lahey Clinic since 1994. The technique, using induction of a pneumothorax and moderate sedation in a spontaneously breathing patient, has been described elsewhere. 119 patients underwent the procedure between 1994 and 2003. We report a retrospective review of 25 of those patients diagnosed with non-malignant pleural effusion after diagnostic pleuroscopy. All 25 patients underwent thoracoscopic pleural biopsy and cytologic examination of the effusion. Outcomes were assessed using review of the medical records, appointment scheduler, social security death index, and/or telephone conversation with primary care providers.

RESULTS: Mean age +/- SD 68 years (range, 34 to 87 years). Mean survival time was estimated at 96 months. Median survival time was estimated at 114 months. Concomitant illness was also evaluated: 40%(n=10) diabetes, 64%(n=16) coronary artery disease, 40% (n=10) congestive heart failure, 20% (n=5) liver disease, 20% (n=5) renal disease, 36% (n=9) pulmonary disease. Final diagnoses after pleuroscopy included chylous effusion (n=1), exudative effusion of unknown etiology (n=2), fibrous scar (n=1), hepatic hydrothorax (n=1), pleural plaques (n=5), chronic pleuritis (n=7), pneumonitis (n=1), post-CABG (n=1), transudative effusion of unclear etiology (n=3), tuberculous pleurisy (n=1), effusion with eosinophilia (n=1), yellow nail syndrome (n=1). 80% survival was noted at 54 months. None of the 25 patients developed subsequent MPE.

CONCLUSION: Patients diagnosed with non-malignant pleural effusions after pleuroscopy have a favorable prognosis and are unlikely to be subsequently diagnosed with a MPE.

CLINICAL IMPLICATIONS: Medical thoracoscopy (pleuroscopy) is a useful tool in diagnosing AND EXCLUDING malignant pleural effusions.

DISCLOSURE: Fares Mouchantaf, No Financial Disclosure Information; No Product/Research Disclosure Information