Is there a need for Vedio-assisted Thoracoscopic surgical (VATS) pleural biopsy following a Medical Thoracoscopy (MT)?

Abstract

Background: MT has a diagnostic sensitivity 92-93% for malignancy. Major complications are rare and negates the need for General Anaesthesia required for VATS. The conventional practice is to refer for VATS biopsy if the MT is inconclusive or negative for malignancy. Aim: To find out the diagnostic yield of MT, assess concordance of histology between MT and VATS biopsy, review major complications, deaths, length of hospital stay and success rate following talc poudrage. Method: We retrospectively analysed all patients who underwent MT over a 2 year period (2015 and 2016) using a semi-rigid thoracoscope.37cases were identified. Histology results for all cases reviewed along with the lung MDT decision on the diagnosis. Results: 37 patients underwent MT over 2 years. 32/37 had a representative pleural biopsy and a conclusive diagnosis following MT. 5/37 was referred for VATS pleural biopsy. 1/5 likely Mesotheloma, 2/5 showed inflammation but felt the pleural appearance warrants further biopsy. 2/5 did not have a representative sample from MT due to severe adhesions and lcoulation therefore needed surgical pleural biopsy but were not fit. Therefore 3/5 underwent VATS pleural biopsy and histology result showed similar findings as of MT. No deaths were noted. Major complication rate was 2.7%. Succcessful Talc Poudrage was noted in 87%. Diagnostic yield was 35/37 (95%). Average hospital stay was 2.5 days. Conclusion: There was 100% concordance between MT and VATS pleural biopsy. If good pleural biopsies are obtained via MT there is little merit doing a surgical biopsy, though we are cautious due to small sample size. Our data also suggest semi-rigid MT has excellent diagnostic yield.