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Meta-Analysis
. 2022 Dec 21;31(166):220053.
doi: 10.1183/16000617.0053-2022. Print 2022 Dec 31.

Sensitivity and complications of thoracentesis and thoracoscopy: a meta-analysis

Gabriela Martinez-Zayas  1 , Sofia Molina  1 , David E Ost  2
Affiliations
Meta-Analysis

Sensitivity and complications of thoracentesis and thoracoscopy: a meta-analysis

Gabriela Martinez-Zayas et al. Eur Respir Rev. .

Abstract

Background: Thoracentesis and thoracoscopy are used to diagnose malignant pleural effusions (MPE). Data on how sensitivity varies with tumour type is limited.

Methods: Systematic review using PubMed was performed through August 2020 to determine the sensitivity of thoracentesis and thoracoscopy for MPE secondary to malignancy, by cancer type, and complication rates. Tests to identify sources of heterogeneity were performed. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 and National Institutes of Health quality assessment tools. Publication bias was tested using funnel plots.

Results: Meta-analyses for sensitivity of thoracentesis for MPE secondary to malignancy, mesothelioma and lung and breast cancer included 29, eight, 12 and nine studies, respectively. Pooled sensitivities were 0.643 (95% CI 0.592-0.692), 0.451 (95% CI 0.249-0.661), 0.738 (95% CI 0.659-0.836) and 0.820 (95% CI 0.700-0.917), respectively. For sensitivity of thoracoscopy for MPE secondary to malignancy and mesothelioma, 41 and 15 studies were included, respectively. Pooled sensitivities were 0.929 (95% CI 0.905-0.95) and 0.915 (95% CI 0.871-0.952), respectively. Pooled complication rates of thoracentesis and thoracoscopy were 0.041 (95% CI 0.025-0.051) and 0.040 (95% CI 0.029-0.052), respectively. Heterogeneity was significant for all meta-analyses. Funnel plots were asymmetric.

Interpretation: Sensitivity of thoracentesis varied significantly per cancer type. Pooled complication rates were low. Awareness of how sensitivity of thoracentesis changes across cancers can improve decision-making when MPE is suspected.

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Conflict of interest statement

Conflicts of interest: G. Martinez-Zayas, S. Molina and D.E. Ost have no conflicts of interest to disclose and take full responsibility for this paper.

Figures

FIGURE 1
FIGURE 1
Study selection algorithm. Results of search and study selection algorithm for sensitivity and complication rates of a) thoracentesis and b) thoracoscopy.
FIGURE 2
FIGURE 2
Forest plot: sensitivity of thoracentesis. Pooled estimate for sensitivity (ES) of thoracentesis for malignant pleural effusion secondary to any malignancy. TP: true positives; FN: false negatives.
FIGURE 3
FIGURE 3
Forest plots: sensitivity of thoracentesis by cancer type. Sensitivity of thoracentesis for malignant pleural effusion secondary to a) mesothelioma, b) lung cancer and c) breast cancer. ES: estimated sensitivity; TP: true positives; FN: false negatives.
FIGURE 4
FIGURE 4
Forest plot: sensitivity of thoracoscopy for malignant pleural effusion secondary to any malignancy. ES: estimated sensitivity; TP: true positives; FN: false negatives.
FIGURE 5
FIGURE 5
Forest plot: sensitivity of thoracoscopy by cancer type. Sensitivity of thoracoscopy for malignant pleural effusion secondary to mesothelioma. ES: estimated sensitivity; TP: true positives; FN: false negatives.
See this image and copyright information in PMC

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