From the Guidelines
The sensitivity of cytology for thoracoscopy is approximately 62% for diagnosing malignant pleural effusions, as reported in the most recent and highest quality study 1. This means that cytological examination of pleural fluid obtained during thoracoscopy will correctly identify cancer cells in about 62% of cases where cancer is actually present.
Key Points to Consider
- The sensitivity of cytology varies depending on the type of malignancy, with some studies suggesting higher detection rates for certain types of cancer 1.
- Multiple samples (at least 3-4) should be taken from different areas of suspicious pleural lesions to improve diagnostic yield.
- Processing samples promptly and using both conventional cytology and cell block techniques can further enhance sensitivity.
- False negatives may occur due to sampling error, low tumor cell shedding, or technical factors in specimen processing.
- When cytology alone is insufficient, combining it with pleural biopsy during thoracoscopy significantly increases the diagnostic accuracy to over 95%, as shown in a study of 206 patients 1.
Diagnostic Approach
- For optimal results, both fluid cytology and direct pleural biopsies should be obtained during thoracoscopic procedures when malignancy is suspected.
- Thoracoscopy should be considered when less invasive tests have failed to give a diagnosis, as recommended by the BTS guidelines 1.
- The procedure has a high diagnostic sensitivity for malignancy, with a reported sensitivity of 95% in one study 1, and can also provide therapeutic benefits, such as talc pleurodesis.
From the Research
Sensitivity of Cytology for Thoracoscopy
- The sensitivity of cytology (cell examination) for thoracoscopy (thoracoscopic examination) is not directly stated in the provided studies.
- However, the sensitivity of pleural fluid cytology is mentioned in several studies:
- A study from 2020 2 reported a sensitivity of 55.0% for pleural fluid cytology in patients with pulmonary metastases and malignant pleural effusion.
- A study from 2012 3 reported a sensitivity of 69% for pleural fluid cytology in patients with malignant pleural effusion, with 46 out of 66 patients showing malignant cells in pleural fluid cytology examination.
- The sensitivity of imprint cytology of thoracoscopic pleural biopsy tissue is reported in a study from 2021 4 as 92% (49 of 53 cases) in cases of malignant pleural effusion and 75% (9 of 12 cases) in cases of tuberculosis pleural effusions.
- A study from 1981 5 reported a diagnostic yield of 97% for thoracoscopy using a 7-mm diameter thoracoscope with biopsy forceps connected to a diathermocoagulating device, but this is not directly comparable to the sensitivity of cytology.
- The study from 2022 6 mentions that the sensitivity of pleural fluid cytology varies based on tumor type, resulting in a limited value of repeated thoracenteses in many cases, but does not provide a specific sensitivity value for cytology in the context of thoracoscopy.