The limitations of CT in excluding pleural malignancy: Insights from LAT (local anesthsia Thoracoscopy) and histology findings

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Introduction A contrast-enhanced CT scan is a key component of the diagnostic workup for patients with unilateral pleural effusion, as recommended by the British Thoracic Society (BTS) Pleural Guidelines. CT imaging demonstrates high specificity when features such as nodular pleural thickening, mediastinal pleural involvement, or pleural thickness >1 cm are present. However, the absence of these features and the presence of benign-appearing pleura on CT raises the question: does this exclude pleural malignancy? Method We retrospectively reviewed the histology and CT reports of all patients who underwent local anesthesia thoracoscopy (LAT) for unilateral pleural effusion over an 18-month period. A total of 35 patients underwent LAT, of whom 34 had prior CT imaging. The mean age was 73 years, and 85.7% (n=30) were male. Results: erj;66/suppl_69/PA1810/F1 F1 F1 Among patients with abnormal CT findings, 81.9% had malignancy, while 18.1% had benign histology. Of the 12 patients with normal CT findings, 33.3% were later diagnosed with epithelioid mesothelioma. Conclusion CT imaging is crucial in assessing pleural malignancy but cannot reliably exclude it based on normal pleural appearances, especially in cases like malignant mesothelioma. Further diagnostic abilities, such as LAT, are essential for accurate diagnosis and management in patients with pleural effusion.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.