Pleural Touch Preparations and Direct Visualization of the Pleura during Medical Thoracoscopy for the Diagnosis of Malignancy.

Pleural Touch Preparations and Direct Visualization of the Pleura during Medical Thoracoscopy for the Diagnosis of Malignancy.

Ann Am Thorac Soc. 2017 Apr 13;:

Authors: Grosu HB, Vial-Rodriguez M, Vakil E, Casal RF, Eapen GA, Morice R, Stewart J, Sarkiss MG, Ost DE

Abstract
RATIONALE: During diagnostic thoracoscopy, talc pleurodesis following biopsy is appropriate if the probability of malignancy is sufficiently high. Findings on direct visual assessment of the pleura during thoracoscopy, rapid onsite evaluation (ROSE) of touch preparations (touch preps) of thoracoscopic biopsy specimens and preoperative imaging, may help predict the likelihood of malignancy; however, data on the performance of these methods are limited.
OBJECTIVE: To assess the performance of ROSE of touch preps, direct visual assessment of the pleura during thoracoscopy and preoperative imaging in diagnosing malignancy.
METHODS: Patients who underwent ROSE of touch preps during thoracoscopy for suspected malignancy were retrospectively reviewed. Malignancy was diagnosed on the basis of final pathologic examination of pleural biopsy specimens. ROSE results were categorized as malignant, benign, or atypical cells. Visual assessment results were categorized as tumor studding present or absent. Positron emission tomography (PET) and computed tomography (CT) findings were categorized as abnormal or normal pleura. Likelihood ratios (LRs) were calculated for each category of test result.
RESULTS: The study included 44 patients, 26 (59%) with a final pathologic diagnosis of malignancy. LRs were as follows: for ROSE of touch preps, malignant, 1.97 (95% confidence interval [CI] 0.90-4.34), atypical cells, 0.69 (95% CI 0.21-2.27), benign, 0.11 (95% CI 0.01-0.93); for direct visual assessment, tumor studding present, 3.63 (95% CI 1.32-9.99), tumor studding absent, 0.24 (95% CI 0.09-0.64); for PET, abnormal pleura, 9.39 (95% CI 1.42-62), normal pleura, 0.24 (95% CI 0.11-0.52); and for CT, abnormal pleura, 13.15 (95% CI 1.93-89.63), normal pleura, 0.28 (95% CI, 0.15-0.54).
CONCLUSIONS: A finding of no malignant cells on ROSE of touch preps during thoracoscopy lowers the likelihood of malignancy significantly while finding of tumor studding on direct visual assessment during thoracoscopy only moderately increases the likelihood of malignancy.A positive finding on PET and or CT increases the likelihood of malignancy significantly in a moderate risk patient group and can be used as an adjunct to predict malignancy prior to pleurodesis.

PMID: 28406718 [PubMed - as supplied by publisher]

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