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Titolo:
THE IMPACT OF THORACOSCOPY ON THE MANAGEMENT OF PLEURAL DISEASE
Autore:
HARRIS RJ; KAVURU MS; MEHTA AC; MEDENDORP SV; WIEDEMANN HP; KIRBY TJ; RICE TW;
Indirizzi:
CLEVELAND CLIN FDN,DEPT PULM & CRIT CARE MED,A90,9500 EUCLID AVE CLEVELAND OH 44195 CLEVELAND CLIN FDN,DEPT PULM & CRIT CARE MED CLEVELAND OH 44195 CLEVELAND CLIN FDN,DEPT BIOSTAT & EPIDEMIOL CLEVELAND OH 44195 CLEVELAND CLIN FDN,DEPT CARDIOVASC & THORAC SURG CLEVELAND OH 44195
Titolo Testata:
Chest
fascicolo: 3, volume: 107, anno: 1995,
pagine: 845 - 852
SICI:
0012-3692(1995)107:3<845:TIOTOT>2.0.ZU;2-B
Fonte:
ISI
Lingua:
ENG
Soggetto:
DIAGNOSTIC PROCEDURE; NEEDLE-BIOPSY; EFFUSION; ANESTHESIA;
Keywords:
MALIGNANCY; PLEURAL DISEASE; THORACOSCOPY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
28
Recensione:
Indirizzi per estratti:
Citazione:
R.J. Harris et al., "THE IMPACT OF THORACOSCOPY ON THE MANAGEMENT OF PLEURAL DISEASE", Chest, 107(3), 1995, pp. 845-852

Abstract

Study objective: To describe the diagnostic efficacy, morbidity, and patient outcome of thoracoscopy; to quantify the direct impact of thoracoscopy on clinical management; and to determine preoperative variables associated with finding malignancy at thoracoscopy to aid patient selection. Design: Retrospective chart review of consecutive cases of thoracoscopy for pleural disease. Setting: Single tertiary medical center. Patients: One hundred eighty-two consecutive patients who underwent thoracoscopy for pleural disease over a 5-year period (from 1987 through 1992). Measurements and results: Final diagnoses were 98 (54%) malignant, 58 (32%) benign, and 26 (14%) idiopathic. Thoracoscopy had a diagnostic sensitivity of 95% for malignancy and 100% for benign disease. Malignancy was shown by thoracoscopy in 27 of 41 (66%) patients who had a preoperative nondiagnostic closed pleural biopsy, and in 24 of35 (69%) patients who had at least 2 preoperative negative pleural cytologic specimens. Chart review by preestablished criteria showed information obtained from thoracoscopy directly influenced treatment in 155 (85%) patients. Thirty-seven (20%) patients, however, had at least one perioperative complication (15% major, 8% minor). Ten (6%) patientsdied during the same hospitalization in which a thoracoscopy was performed, although none died within 48 h. There was one thoracoscopy-related death. Sixty-two (34% patients died within 6 months of thoracoscopy (death by all causes). Forty-seven (48%) patients who had intrathoracic malignancy present at thoracoscopy died within 6 months. Patients found to have malignant pleural disease by thoracoscopy were more likely to have a preoperative history of a malignancy (p=0.001). Age more than 50 years was associated with finding malignancy at thoracoscopy (p=0.04). A combined lymphocytic and hemorrhagic effusion was associated with malignancy(p=0.004). Preoperative pleural data showed that idiopathic effusions had a significantly lower median lactate dehydrogenase (LDH) value (192, which was normal) compared with malignant or benign effusions. Conclusions: (1) Thoracoscopy increases yield for malignant and benign disease when thoracentesis and closed pleural biopsy arenondiagnostic. (2) Thoracoscopy directly affects clinical management in 85% of patients. (3) Significant complications can occur in patients receiving tertiary care. (4) For the evaluation of suspected malignant pleural disease, thoracoscopy has its greatest diagnostic yield in older patients who have a history of malignancy and who present with alymphocytic, hemorrhagic, high LDH effusion.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 11/07/20 alle ore 03:41:18