Visual Assessment and Rapid On-Site Evaluation for Touch Imprints from Biopsy Tissue in Diagnosing Pleural Effusion Using Medical Thoracoscopy

Background: Rapid and accurate diagnosis during thoracoscopy is crucial for guiding management in pleural disease. We evaluated the diagnostic performance of expert gross pleural appearance versus Rapid On-Site Evaluation (ROSE) of touch imprints for distinguishing malignant from benign pleural pathology. Methods: Thirty-three patients underwent medical thoracoscopy. Demographic, clinical, and fluid characteristics were recorded. Thoracoscopic visual assessment and in-procedure ROSE were compared against histopathology. Diagnostic metrics (sensitivity, specificity, accuracy, predictive values), ROC analysis (AUC), and Cohen’s κ agreement were calculated. Results: Mean age was 57.1 ± 13.2 years; malignancy was confirmed in 75.8% of cases (25/33). Mesothelioma (45.5%) and metastatic adenocarcinoma (27.3%) predominated. Pleural fluid color did not significantly differ by diagnosis (p = 0.618). Gross visual assessment yielded sensitivity 96.0%, specificity 50.0%, accuracy 80.0%, and AUC 0.793; PPV 88.9%, NPV 83.3%. ROSE achieved sensitivity 80.0%, specificity 100.0%, accuracy 87.9%, and AUC 0.920 (p < 0.001); PPV 100.0%, NPV 66.7%. Agreement between ROSE and histopathology was good (κ = 0.718; 95% CI 0.469–0.967; p < 0.001). Conclusion: While thoracoscopic visual assessment offers high sensitivity, its specificity is limited. ROSE markedly enhances diagnostic precision and agrees well with histopathology. Combined use of both modalities may optimize intraoperative decision-making in pleural disease