Diagnosis of Carcinomatous Pleurisy using Thoracoscopy-A Comparative Study of Thoracoscopic Findings, Pleural Fluid Cytology, Fluid CEA Levels and Fluid Amount, and Clinical Features of Cases Diagnosed Definitively by only Thoracoscopic Pleural Biopsy

The subjects of this study were 31 patients with carcinomatous pleurisy upon whom thoracoscopic pleural biopsies were performed between July 1987 and September 1993. Thoracoscopic findings were compared with the findings of fluid cytology, fluid CEA levels and fluid amount disclosed by chest X-ray. The clinical features of five cases diagnosed definitively by only thoracoscopic pleural biopsy were discussed. The total positive ratio of thoracoscopic pleural biopsies was high (84%). Macroscopic findings under thoracoscopy were divided into two groups; localized tumorous type and diffuse invasive type. In the localized tumorous type pleural fluid cytology showed negative findings in 7 cases and positive findings in 8 cases. Fluid CEA levels were over 30ng/ml in 6 cases and under 3Ong/ml in 9. Fluid amounts were small, moderate and large in 6, 7 and 3 cases, respectively. In diffuse invasive type cases, pleural fluid cytology showed negative findings in 3 cases and positive findings in 13 cases. Fluid CEA levels were under 3Ong/ml in 6 cases and over 30ng/ml in 8 cases. Fluid amounts were small, moderate and large, in 0, 8 and 8 cases, respectively. Based on these results, most cases of carcinomatous pleurisy with negative fluid cytology, low fluid CEA levels and a small amount of pleural fluid involve localized tumors. In such cases, in which the findings of needle biopsies cound be predicted to be negative, visual biopsy using thoracoscopy would be useful. In a clinical study of 5 cases diagnosed by only thoracoscopic pleural biopsy, the pleural fluid amounts varied from small to large, but all fluid CEA levels were under 15ng/ml, and mean surviving period after examination was relatively long, 233 days. Such cases were considered to be diagnosed in the early stage of pleural invasion. Therefore, we concluded that thoracoscopic pleural biopsy would be helpful in making a diagnosis of carcinomatous pleurisy at an early stage.