Clinical experience with pleuroscopy utilizing the bronchofiberscope

Our plain-English summary of Clinical experience with pleuroscopy utilizing the bronchofiberscope, by G.R. Kerby, G. Pierce, W.E. Ruth (The Annals of Otology, Rhinology, and Laryngology, 1975).

The study

• Authors: G.R. Kerby, G. Pierce, W.E. Ruth
• Journal: The Annals of Otology, Rhinology, and Laryngology
• Published: 1975;84(5 Pt 1):602-6
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The gas sterilized bronchofiberscope has been utilized as a pleuroscope for visual exploration of the pleural space and forceps biopsy of abnormal lesions in 16 patients with undiagnosed pleural disease. The instrument was inserted through a small (1-2 cm) incision. Aspiration of pleural fluid and instillation or aspiration of air to produce a controlled pneumothorax are easily accomplished through the instrument's suction channel. In eight patients with undiagnosed pleural effusion, biopsy of visualized nodules established the diagnosis of carcinoma. Three patients with bronchogenic carcinoma and pleural effusion had no pleural metastases at pleuroscopy which was confirmed in two patients who had thoracotomy and lung resection. Parenchymal subpleural nodules of metastatic carcinoma were confirmed by pleuroscopic biopsy in one patient. Biopsy via the pleuroscope was unsuccessful in two patients, one with pleural fibrosis, probably related to asbestosis, and one with mesothelioma. Both required open surgical biopsy of the pleura. There has been minimal patient discomfort and no serious complications.

In plain English

This article reported the authors' clinical experience using a flexible bronchofiberscope, an instrument normally used to look into the airways, as a pleuroscope. They used it to look inside the space around the lungs (the pleural space) and to take biopsies in 16 patients with undiagnosed pleural disease, at the University of Kansas School of Medicine. The scope was inserted through a 1 to 2 cm incision. Biopsy through the scope gave a tissue diagnosis of malignancy in eight patients. In three patients with bronchogenic carcinoma and pleural effusion, no pleural metastases were seen; this was confirmed in two who had thoracotomy and lung resection. Biopsy through the scope failed in two patients. One had pleural fibrosis that the authors described as probably related to asbestosis, and the other had mesothelioma. Both needed open surgical biopsy. The article did not study asbestos exposure. The authors reported minimal patient discomfort and no serious complications. They concluded that pleuroscopy is a useful adjunct in diagnosing pleural disease.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case series: a report of the authors' clinical experience with a diagnostic procedure
• Who was studied: 16 patients with undiagnosed pleural disease, Division of Pulmonary Disease, University of Kansas School of Medicine, Kansas City, Kansas; 13 had undiagnosed pleural effusion. Study dates were not stated.
• Exposure: No asbestos exposure was studied. The article evaluated a diagnostic procedure, pleuroscopy with a bronchofiberscope. One patient's pleural fibrosis was described as probably related to asbestosis, but no exposure history was given.
• Main results:
  • Pleuroscopy provided a tissue diagnosis of malignancy in eight of the 16 patients
  • Three patients with bronchogenic carcinoma and pleural effusion had no pleural metastases at pleuroscopy; this was confirmed in two patients who had thoracotomy and lung resection
  • In two other patients with apparently benign pleural effusion, normal findings supported follow-up without therapy in one and antituberculous therapy in the other
  • Biopsy through the pleuroscope was unsuccessful in two patients, one with pleural fibrosis probably related to asbestosis and one with mesothelioma
  • Both of these patients required open surgical biopsy of the pleura
  • Patient discomfort was minimal and there were no serious complications. The table listed fever, a small pneumothorax and pain in some patients.
• The authors' conclusion: The authors concluded that pleuroscopy is a useful adjunct in the diagnosis of pleural disease, that the bronchofiberscope is generally available and adequate, and that the procedure is simple with minimal complications to date.
• Limitations the authors state:
  • Because the pleural space has few landmarks, the examination was somewhat random
  • In the mesothelioma patient with thick pleural plaques, the small biopsy forceps was technically unable to obtain an adequate specimen

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Biopsy, Pneumothorax, Pleural Effusion, Carcinoma, Bronchogenic Carcinoma, Thoracotomy, Fibrosis, Mesothelioma.

Related studies

• Transbronchial needle aspiration for histology specimens — A.C. Mehta, M.S. Kavuru, et al. (1989)
• Flex-rigid pleuroscopy under local anesthesia in patients with dry pleural dissemination on radiography — Y. Watanabe, S. Sasada, et al. (2014)
• Advances in pleuroscopy — S. Anevlavis, M.E. Froudarakis (2018)
• Rounded atelectasis. Clinical experience with 74 patients — G. Hillerdal (1989)
• Computer tomography in the evaluation of pulmonary asbestosis. Preliminary experiences with the EMI general purpose scanner — L. Kreel (1976)
• First report of probe based confocal laser endomicroscopy during medical thoracoscopy — O. Bonhomme, B. Duysinx, et al. (2019)

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