P200 Objective thoracoscopic criteria in differentiation between benign and malignant pleural effusions

• Published in: Thorax Vol. 76; no. Suppl 1; pp. A198 - A199
• Main Authors: Ellayeh, MA, Bedawi, EO, Banka, R, Sundaralingam, A, George, V, Kanellakis, NI, Hallifax, RJ, Abdelwahab, HW, Hewidy, AA, Ali, RE, Rahman, NM
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.02.2021
• Subjects: Inflammation
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax-2020-BTSabstracts.345

BackgroundThoracoscopy is the ‘gold standard’ diagnostic modality for investigation of suspected pleural malignancy.1 It is postulated that meticulous assessment of the pleural cavity may be adequate to diagnose malignancy through finding of nodules, pleural thickening and lymphangitis.2 Given the increased uptake of local anaesthetic thoracoscopy (LAT) recently, we attempted to define precise, objective criteria to differentiate benign from malignant pleural diseases according to the pattern, anatomical site and exploring predilection of abnormalities to specific sites on the pleural surfaces.MethodsA structured review of recorded video footage from LAT procedures in 96 patients was conducted by 2 independent assessors. Abnormalities were scored according to the presence or absence of nodules, lymphangitis, inflammation on each of the parietal, visceral and diaphragmatic surfaces, respectively. The parietal pleura was divided into 6 levels (apical, middle, and inferior of the lateral surface and apical, middle, and inferior of the posterior surface). The anterior surface of the parietal pleura was excluded due to difficulty of assessment.ResultsIn the benign group, inflammation was the predominant finding in 65%(n=33; parietal), 44%(n=21; visceral) and 42%(n=15; diaphragmatic). Nodules were detected in 24%(n=12; parietal), 8% (n=4; visceral) and 8%(n=3; diaphragmatic). The most affected surfaces with inflammation were the middle lateral (60%) and the inferior lateral (57.8%) parts of the parietal pleura.In the malignant group, nodules were the predominant finding in 73%(n=33; parietal), 32%(n=13; visceral) and 48%(n=17; diaphragmatic). Inflammation was detected in 44%(n=20; parietal), 25%(n=10; visceral) and 29%(n=10; diaphragmatic). The most affected surfaces with nodules were the middle lateral (67.4%) and the inferior lateral (66.7%) parts of the parietal pleura.ConclusionThis study suggests that macroscopic assessment at LAT can differentiate between benign and malignant pleural disease, with the predominance of inflammation and nodules, respectively. In addition, pleural abnormalities appear to have an anatomical predilection, emphasising the importance of inspection and sampling of these areas. The finding that nodules were seen in approximately 1 in 4 benign patients on the parietal pleura is of interest and warrants further exploration in a larger cohort.ReferencesRahman NM. Thorax 2010; 65: ii54–ii60.Boutin C. Endoscopy 1980; 12(04): 155–160.