Eksudatif Plevral Efüzyonda Torakoskopik Biyopsinin Tanısal Rolü ve Uzun Dönem Takip Sonuçları

Yıl 2023, , 67 - 73, 19.01.2024

Hıdır Esme

https://doi.org/10.33716/bmedj.1302275

Öz

Giriş: Eksudatif plevral efüzyonların %20’sinde, tekrarlayan torasentez ve perkutan plevral biyopsiye rağmen tanısı konulamaz. Bu çalışmanın amacı daha az invaziv yöntemlerle tanısı konulamayan eksüdatif PE olan hastalarda yapılan torakoskopik biyopsinin etkinliği ve işlem sonrası uzun dönem takiplerin gözden geçirilmesidir.
Gereç ve Yöntem: Ocak 2016 ile Aralık 2020 tarihleri arasında eksüdatif PE nedeniyle torakoskopik biyopsi uygulanan hastalar geriye dönük incelendi. Postoperatif en az 2 yıl takip edilebilen hastalar çalışmaya dahil edildi. Klinik ve fizik muayene, kan tahlilleri, plevral sıvının biyokimyasal, bakteriyolojik ve sitolojik incelemeleri, radyolojik ve histopatolojik veriler elde edildi.
Bulgular: Hastaların 45'i (%61.6) erkek, 28'i (%38.3) kadındı. Yaş ortalaması 56,5±13,2 idi. Hiçbir hastada intraoperatif komplikasyon gelişmedi. Postoperatif dönemde 7 (%9) hastada komplikasyon gelişti. Üç (%4.1) hastada uzamış hava kaçağı, 2 (%2.7) hastada yara yeri enfeksiyonu ve 2 (%2.7) hastada pnömoni gelişti. Hastaların 21’inde (%28.7) malignite saptanırken 52 (%71.2) hastada benign patolojiler saptandı. Takip sırasında daha önce nonspesifik plörit tanısı alan ve tekrarlayan PE nedeniyle torakoskopik biyopsi yapılan 4 (%5.4) hastadan 2’sinde (%2.7) malign mezotelyoma saptandı.
Tartışma: Sonuç olarak eksudatif PE’nin tanısında torakoskopik biyopsi tanısal değeri yüksek ve komplikasyonları nadir bir yöntemdir. Nonspesifik plevrit sonrası malignite gelişimi genellikle 1 yıl içerisinde olmakla birlikte nadiren 2 yıl içinde de gelişebilir. Bu nedenle nonspesifik plevrit sonrası takip süresinin 2 yıl olması gerektiği kanaatindeyiz.

Anahtar Kelimeler

Eksüda, torakoskopi, takip

The diagnostic role of thoracoscopic biopsy in exudative pleural effusion and long-term follow-up results

Öz

Aim: In 20% of exudative pleural effusions, the diagnosis cannot be established despite repeated thoracentesis and percutaneous pleural biopsy. The aim of this study was to review the effectiveness of thoracoscopic biopsy performed in patients with exudative PE that could not be diagnosed with less invasive methods and their long-term follow-up after the procedure.
Materials and Methods: Patients who underwent thoracoscopic biopsy for exudative PE between January 2016 and December 2020 were retrospectively analyzed. Patients who were followed up for at least 2 years postoperatively were included in the study. Clinical and physical examination, blood tests, biochemical, bacteriological and cytological examinations of pleural fluid, radiological and histopathological data were obtained.
Results: Forty five (61.6%) of the patients were male and 28 (38.3%) were female. The mean age was 56.5±13.2 years. No intraoperative complications developed in any patient. Complications developed in 7 (9%) patients in the postoperative period. Prolonged air leakage developed in three (4.1%), wound infection in 2 (2.7%), and pneumonia in 2 (2.7%) patients. While malignancy was detected in 21 (28.7%) patients, benign pathologies were detected in 52 (71.2%) patients. During follow-up, malign mesothelioma was detected in 2 (2.7%) of 4 (5.4%) patients who were previously diagnosed with nonspecific pleuritis and underwent thoracoscopic biopsy due to recurrent PE.
Conclusion: Thoracoscopic biopsy is a method with high diagnostic value and rare complications in the diagnosis of exudative PE. Although the development of malignancy after nonspecific pleuritis is usually within 1 year, it can also develop within 2 years. Therefore, we believe that the follow-up period after nonspecific pleuritis should be 2 years.

Anahtar Kelimeler

Exudate, thoracoscopy, follow-up

Kaynakça

• Semaan R, Feller-Kopman D, Slatore C, Sockrider M. Malignant Pleural Effusions. Am J Respir Crit Care Med 2016; 194: P11-P12
• Jany B, Welte T. Pleural Effusion in Adults-Etiology, Diagnosis, and Treatment. Dtsch Arztebl Int 2019; 116: 377-386
• Lee P, Folch E. Thoracoscopy: Advances and Increasing Role for Interventional Pulmonologists. Semin Respir Crit Care Med 2018; 39: 693-703 [PMID: 30641587
• Anevlavis S, Froudarakis ME. Advances in pleuroscopy. Clin Respir J 2018; 12: 839-847 Colt HG. Thoracoscopy. Chest 1995;108:324–9
• Reuter SB, Clementsen PF, Bodtger U. Incidence of malignancy and survival in patients with idiopathic pleuritis. J Thorac Dis 2019;11:386–92.
• Venekamp LN, Velkeniers B, Noppen M. Does 'idiopathic pleuritis' exist? Natural history of non-specific pleuritis diagnosed after thoracoscopy. Respiration 2005;72:74–8.
• Boutin C, Astoul P, Seitz B. The role of thoracoscopy in the evaluation and management of pleural effusions. Lung 1990;168 Suppl:1113–21.
• Metintas M, Ak G, Cadirci O, et al. Outcome of patients diagnosed with fibrinous pleuritis after medical thoracoscopy. Respir Med 2012;106:1177–83.
• Ryan CJ, Rodgers RF, Unni KK, et al. The outcome of patients with pleural effusion of indeterminate cause at thoracotomy. Mayo Clin Proc 1981;56:145–9.
• Celik M, Halezaroglu S, Senol C, Keles M, Yalcin Z, Urek S, et al. Video- assisted thoracic surgery: experience 341 cases. Eur J Cardiothorac Surg. 1998; 14: 113-6.
• Caccavale RJ, Lewis RJ. Video-assisted thoracic surgery as a diagnostic tool. In: Shields TW, Lo Cicero III J, Ponn RB, eds. General Thoracic Surgery. Philadelphia: Lippincott Williams &Willkins, 2000; pp- 285-93.
• Medford A, Awan YM, Marchbank A, Rahahim J, Unsworth-White J, Pearson PJK. Diagnostic and therapeutic performance of videoassisted thoracoscopic surgery (VATS) in investigation and management of pleural exudates. Ann R Coll Surg Engl. 2008; 90: 597-600.
• Soni A, Bansal V, Goel A. The role of thoracoscopy in diagnosis and pleural disease. World J Lap Surg 2012; 5: 4-15.
• Solli P, Spaggiari L. Indications and developments of videoassisted thoracic surgery in the treatment of lung cancer. Oncologist. 2007; 12: 1205-14.
• Astoul P, Boutin C, Seitz B. Diagnosis of pleurisy. Rev Prat. 1990; 40: 1829-36.
• Davies HE, Nicholson JE, Rahman NM, Wilkinson EM, Davies RJ, Lee YC. Outcome of patients with nonspecific pleuritis/fibrosis on thoracoscopic pleural biopsies. Eur J Cardiothorac Surg. 2010; 38:472-7.
• Venekamp LN, Velkeniers B, Noppen M. Does 'idiopathic pleuritis' exist? Natural history of non-specific pleuritis diagnosed after thoracoscopy. Respiration. 2005; 72: 74-8.
• Ferrer JS, Munoz XG, Orriols RM, Light RW, Morell FB.Evolution of idiopathic pleural effusion: a prospective, longterm follow-up study. Chest 1996;109:1508–13.
• Gunluoglu G, Olcmen A, Gunluoglu MZ, Dincer I, Sayar A, Camsari G, et al. Long-term outcome of patients with undiagnosed pleural effusion. Arch Bronconeumol. 2015; 51: 632-6.
• Yang Y, Wu YB, Wang Z, Wang XJ, Xu LL, Tong ZH,et al. Long-term outcome of patients with nonspecific pleurisy at medical thoracoscopy. Respir Med. 2017; 124:1-5.
• Deschuyteneer EP, De Keukeleire T. Diagnostic value and safety of thoracoscopic pleural biopsies in pleural exudative effusions of unknown origin, including follow-up. BMJ Open Respir Res. 2022 Mar;9(1):e001161. doi: 10.1136/bmjresp-2021-001161.