La Toracoscopia en el manejo clínico – terapéutico de los derrames pleurales: una técnica vanguardista en el siglo XXI

Abstract

Valorar el rendimiento diagnóstico de la toracoscopia en los derrames pleurales. Estudio prospectivo que incluye a 110 pacientes con derrames pleurales diagnosticados clínicamente como benignos (14,5%), malignos (34,5%) y no filiados (50,9%). A todos se les practicó toracoscopia con anestesia local y sedación consciente para el estudio de la cavidad pleural y la toma de muestras. La toracoscopia confirmó los siguientes diagnósticos: 30,35% como pleuritis inespecífica, 17,86% de mesotelioma y 1,79% de pleuritis tuberculosa. El resto de derrames fueron diagnosticados como malignos por carcinomatosis pleural. La toracoscopia es una técnica con baja morbilidad, de gran utilidad para obtener muestras histológicas para estudio y, por lo tanto, para poder establecer un diagnóstico definitivo en los derrames pleurales.

The aim of this study was to investigate the effectiveness of thoracoscopy in the diagnosis of non-affiliated pleural effusions. A fiveyear prospective study including data from one hundred and ten patients that were clinically diagnosed as benign (14,5 %), malign (34,5 %) and non-affiliated (50,9%). Pleural effusions in patents without oncology disease and negative biopsy or cytology were considered as benign. Malignant diagnosis was established according to a pleural biopsy, compatible cytology and/or clinical features. Remaining cases were considered as non-affiliated. Thoracoscopy was done under local anesthesia and sedation. Thoracoscopy confirmed previous clinical diagnosis of benignity and malignity. Regarding non-affiliated patients the 30,35% were diagnosed after thoracoscopy as unspecific pleuritis, 17,86% of mesotelioma and 1,79% of pleural tuberculosis (TBC). The other 48,21% of patients reported as non-affiliated were diagnosed of pleural carcinoma. Our results indicate that thoracoscopy is a cost effective and reliable technique for obtaining histological diagnosis in PE, and also allows a directed pleurodesis if indicated.