THORACOSCOPY IN MALIGNANT PLEURAL EFFUSIONS

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Abstract
In a consecutive series of 1,000 patients with pleural effusions, 215 with undiagnosed chronic effusions (with previous negative cytologic and needle biopsy results) underwent thoracoscopy. The investigation was usually performed under general anesthesia, originally with a 9-mm diameter cold light laparoscope but later with a 7-mm diameter thoracoscope with biopsy forceps connected to a diathermocoagulating device. Thoracoscopy diagnosed 131 of 150 malignant effusions in the series. No false positive results were observed. A repeat pleural cytology and needle biopsy performed the day before thoracoscopy yielded only 41% positive results. The higher yield by our new thoracoscope (97% positive results vs. 78% with the laparoscope) can be accounted for by a better visualization of the pleural space, easier handling of biopsy material and the systematic use of diathermocoagulation. Complications were rare, minor and not life-threatening.

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