ArticleGeneral thoracic and cardiovascular surgery2026
Combined PET-CT and VATS biopsy in pleural effusion: diagnostic accuracy, surgical factors, and prognosis-a retrospective study.
Article in General thoracic and cardiovascular surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo clarify the combined contribution of positron emission tomography-computed tomography (PET-CT) and video-assisted thoracoscopic surgery (VATS) pleural biopsy to diagnostic accuracy, perioperative outcomes, and long-term prognosis in patients with unexplained pleural effusion.
methodsWe retrospectively reviewed 29 consecutive patients who underwent both PET-CT and VATS biopsy for unexplained pleural effusion between 2009 and 2024. Imaging findings and pathological diagnosis, operative variables, complications, and overall survival were analyzed.
resultsAmong 13 PET-negative patients, 4 (30.8%) had malignancy on VATS biopsy. Among 16 PET-positive patients, 5 (31.3%) had benign pathology. PET-CT findings were not associated with operative time, blood loss, or duration of chest tube. Postoperative complications occurred in 4 patients (13.8%), with no difference between PET-positive and negative groups. Complications included prolonged air leak, difficult-to-control pain, and thromboembolic events. Survival was significantly worse in malignant than benign cases (5-year overall survival: 29% vs. 56%, p = 0.02). When patients were grouped into four combined PET-CT/VATS biopsy categories, survival did not significantly differ among the groups (p = 0.11).
conclusionPET-CT and VATS biopsy were not always concordant, reinforcing the role of VATS biopsy for definitive diagnosis even when PET-CT is negative. Prognosis was more associated with VATS biopsy pathology than with PET-CT. Perioperative complications after VATS biopsy were not uncommon, particularly in patients with multiple comorbidities.
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