Five-year Experience of Using Single Port Rigid Thoracoscopy in Patients of Undiagnosed Exudative Pleural Effusion at Tertiary Center in North India.

Background: Pleural effusion is one of the common pleural diseases encountered by pulmonologists worldwide. Malignancy and tuberculosis are the two most common etiologies in such patients, who have completely different prognoses. Pleural biopsy is the gold standard investigation to diagnose various causes of pleural effusion. Rigid Medical Thoracoscopy is a semi-invasive tool to evaluate the pleura morphologically and take an image-guided biopsy from the pleura for a definitive diagnosis.

Materials and methods: This was a single-center, retrospective data-based study. Data were collected between January 1st, 2020, and December 31st, 2024. Patients with undiagnosed exudative pleural effusion, defined as negative cartridge based nucleic acid amplification for tuberculosis and twice negative pleural fluid cytology for malignancy, underwent rigid thoracoscopy to confirm their diagnosis.

Results: A total of 376 patients underwent thoracoscopy. The mean age of the patients was 58.8 years, and male-to-female ratio was 1.3:1. The most common etiology observed was malignancy, seen in 275 patients (73.1%), followed by tuberculosis in 66 patients (17.5%) and nonspecific inflammation in 25 patients (6.7%). A final diagnosis could be made in 369 patients, giving a diagnostic yield of 98.1%. It was also used to break septations, which ultimately led to the expansion of their lung in 10 patients. Fifteen patients (4%) had major complications, whereas 31 patients (8.2%) had procedure-related minor complications.

Conclusion: Rigid medical thoracoscopy has a very high diagnostic yield with few complications in the diagnosis of exudative pleural effusion. Therefore, tissue-based biopsy with thoracoscopy can be easily performed to make a correct diagnosis with huge future implication in such patients.