Chest
Original ResearchPulmonary ProceduresDiagnostic Accuracy and Safety of Semirigid Thoracoscopy in Exudative Pleural Effusions: A Meta-analysis
Section snippets
Search Strategy
We first searched the PubMed and EMBASE databases for any systematic review reporting the diagnostic efficacy of semirigid thoracoscopy in undiagnosed EPE. One systematic review published in 2010 comprising five studies and 154 patients was found.19 All the authors then independently searched the PubMed (1995 to February 2013) and EMBASE (1995 to February 2013) databases for studies describing the diagnostic value of semirigid thoracoscopy using the following search terms: (1) (thoracoscopy[ti]
Characteristics and Quality of the Studies
Our initial database search retrieved a total of 4,389 citations (Fig 1), of which 17 studies (755 patients with undiagnosed EPEs) finally met our inclusion criteria.17, 18, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46 One study was excluded because of the possibility of overlap of patients.47 The studies have been reported from across the globe, both from the developed and the developing world. Of these, 10 studies were prospective and seven retrospective (Table 1). The criteria
Discussion
The results of this meta-analysis (17 studies, 755 patients with undiagnosed pleural effusions) suggest that semirigid thoracoscopy has good sensitivity (91%) and excellent specificity (100%) in diagnosis of EPEs of undetermined cause. The PLR was 4.92, and the NLR was 0.08. Likelihood ratios > 10 and < 0.1 are considered as strong indicators to rule in or rule out a diagnosis, respectively.48 In clinical practice, 10% of the patients can be potentially missed with semirigid thoracoscopy.
Acknowledgments
Author contributions: Dr Agarwal is guarantor of the paper, taking responsibility for the integrity of the work as a whole, from inception to published article.
Dr Agarwal: contributed to conceiving the article, systematic review, meta-analysis, and drafting and revising the manuscript.
Dr Aggarwal: contributed to the systematic review and drafting and revising the manuscript.
Dr Gupta: contributed to the systematic review and drafting and revising the manuscript.
Financial/nonfinancial disclosures:
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Funding/Support: The authors have reported to CHEST that no funding was received for this study.
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