2009 OPEN FORUM Abstracts
DIAGNOSTIC ACCURACY OF MEDICAL THORACOSCOPY IN DIAGNOSIS OF PLEURAL EFFUSION OF UNDETERMINED ETIOLOGY; A SYSTEMATIC REVIEW
Subhash Chandra1, Dipti Agarwal2, Anant Mohan1, Randeep Guleria1; 1Medicine, All India Institute of Medical Sciences,NewDelhi, India; 2EmergencyMedicine,Mayo Clinic College ofMedicine, Rochester,MN
Background and Objective: A pleural effusion of undetermined etiology (PEUE), where blind pleural aspirate/ biopsy is failed to yield an answer, is often a difficult problem and needs histological study for a definitive etiological diagnosis. Several studies form different parts of the world have proved role of medical thoracoscopy (MT) in diagnosis of PEUE but results are not uniform. Hence, we sought to determine the diagnostic accuracy of MT in PEUE through this systematic review. Methodology: The electronic search was performed in Pubmed without language restriction. References of relevant records and abstracts of American Thoracic Society and CHEST were hand searched. We selected articles for review based on the following criterion: 1) Prospective study, 2) Based on original research, 3) Enrolled consecutive patients of PEUE, 4) Full paper available in English.5) MT preformed under local anesthesia in brochoscopy or endoscopy suite using semi-rigid (flex-rigid) instrument and 6) Reported sufficient data to construct a 2 2 contingency table. We assessed study quality and extracted data independently and in duplicate using a standardized data extraction form. Results: 5 studies met inclusion criterion, encompassing 154 patients. All the procedures were performed under local anesthesia with mild sedation in endoscopy or bronchoscopy suite using semi-rigid (flex-rigid) instrument. During the procedure, patients were positioned in lateral decubitus position with affected side up. Pooled sensitivity (95% CI) was 0.97 (0.92-0.99), specificity (95% CI) was 1.00 (0.69-1.00), positive likelihood ratio (95% CI) was 5.47 (1.11-16.86) and negative likelihood ratio (95%CI) was 0.08 (0.04-0.18). No major complications with 0% 30 days mortality noted. Conclusion: MT is a highly sensitive and specific diagnostic modality in PEUE. Negative likelihood ratio of less than 0.1 (0.08) in our study provides strong evidence to rule out the diseases in most circumstances. Also, it is easy to perform, devoid of anesthesia complications and operation theater requirements. Sponsored Research - None
Forest plot of sensitivity: Point estimates of sensitivity along with 95% confidence intervals (CIs) (horizontal bars) are plotted for each study population.