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Pleuroscopy for the Diagnosis of Cancer in Patients with Pleural Effusion: A Review of the Diagnostic Accuracy, Safety, Cost-Effectiveness and Guidelines

Last updated: April 27, 2020
Project Number: RC1260-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the diagnostic accuracy of medical thoracoscopy (pleuroscopy) for the diagnosis of cancer in patients with pleural effusion of unknown etiology?
  2. What is the safety of pleuroscopy for the diagnosis of cancer in patients with pleural effusion of unknown etiology?
  3. What is the cost-effectiveness of pleuroscopy for the diagnosis of cancer in patients with pleural effusion of unknown etiology?
  4. What are the evidence-based guidelines regarding the use of pleuroscopy for the diagnosis of cancer in patients with pleural effusion of unknown etiology?

Key Message

One systematic review pooled estimates for diagnostic accuracy and found that semi-rigid thoracoscopy had high sensitivity and specificity for diagnosing pleural effusions of unknown etiology. One non-randomized retrospective study observed a high sensitivity and specificity for rigid thoracoscopy for the diagnosis of tuberculous pleural effusion.  Similarly, non-randomized retrospective and prospective studies found a high sensitivity and specificity for rigid or semi-rigid thoracoscopy for the diagnosis of malignant pleural effusion or malignancy. One non-randomized retrospective study reported no statistical difference in diagnostic accuracy between semi-rigid thoracoscopy compared with video-assisted thoracoscopic surgery in the assessment of pleural effusions that were malignant, suspicious for malignancy, or granulomatous inflammation combined.

An economic evaluation reported the mean procedure-related cost of semi-rigid thoracoscopy as $2,815 Canadian dollars (95% Confidence Interval $2,010 to $3,620) compared to video-assisted thoracoscopic surgery of $7,962 Canadian dollars (95% Confidence Interval $7,134 to $8,790) in patients with undiagnosed pleural effusions. Since all video-assisted thoracoscopic surgery was conducted in the hospital whereas 68% of semi-rigid thoracoscopy was performed as outpatient procedures, the longer hospital stay associated with video-assisted thoracoscopic surgery may have contributed to some of the difference in procedure cost.

Among the systematic reviews, randomized, and non-randomized retrospective and prospective studies, few significant procedural complications occurred among patients with undiagnosed pleural effusions that received medical thoracoscopy (pleuroscopy).

One evidence-based guideline suggests that medical thoracoscopy is well tolerated among patients with undiagnosed pleural effusions and exhibits a higher likelihood of diagnosis and pleurodesis in comparison to video-assisted thoracoscopic surgery as patients may have comorbidities and not tolerate general anesthesia.