Evaluation of the efficacy and safety of a new flex-rigid pleuroscope

Our plain-English summary of Evaluation of the efficacy and safety of a new flex-rigid pleuroscope, by S. Ishii, H. Watanabe, M. Suzuki, et al (The Clinical Respiratory Journal, 2021).

The study

• Authors: S. Ishii, H. Watanabe, M. Suzuki, M. Hashimoto, M. Iikura, S. Izumi, M. Hojo, H. Sugiyama
• Journal: The Clinical Respiratory Journal
• Published: 2021;15(1):91-96
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: New flex-rigid pleuroscope enables observations with a maximum angle of curvature of 180° , allowing visualization of the area near the insertion site of the pleuroscope. And, it improved the image quality and channel inner diameter. The aim of this study was to evaluate the clinical effectiveness and safety of a new flex-rigid pleuroscope.

Methods: A retrospective analysis of patients who were examined with a new flex-rigid pleuroscope under local anesthesia at our institution was conducted. Pleuroscopy was performed in 33 patients with undiagnosed exudative pleural effusions from December 2016 to March 2019.

Results: A total of 33 patients (10 women, 23 men); their median age 74 years (range 24-90) were investigated. Pleuroscopy showed that 18 had malignant pleural disease (54%), and 15 had benign pleural diseases (46%). The top three most frequent causes of pleural disease were pleural metastases of lung carcinoma (30.3%), pyothorax (15.1%), and malignant pleural mesothelioma (12.1%). In 32 cases (97%), observation at the introducer insertion site was possible. It was not possible in one case due to hard adhesions. The diagnostic rate was 100%, and the complication rate was 6.1%. There were no major complications, and minor complications included mild pain (one case) and minor bleeding (one case) that was stanched spontaneously.

Conclusions: The new flex-rigid pleuroscope is effective and safe for diagnosing pleural effusions. The improved bending angle is likely to minimize the blind area. The new pleuroscopy fiberscope may improve the diagnostic rate.

© 2020 The Authors. The Clinical Respiratory Journal published by John Wiley & Sons Ltd.

In plain English

This was a single-center retrospective study from the National Center for Global Health and Medicine in Tokyo. It looked at a new flex-rigid pleuroscope, a camera tube for viewing and sampling the lining of the chest under local anesthesia. The authors developed it in association with Olympus. It bends up to 180°, compared with 130° for the conventional model. Thirty-three patients with undiagnosed exudative pleural effusions (fluid around the lung) were examined between December 2016 and March 2019. Doctors could view the area around the insertion site in 32 cases (97%). On pathology, 18 patients had malignant tumors and 15 had benign diseases. These included 4 malignant pleural mesotheliomas (12.1%) and two asbestos-related pleurisy (6.1%). Pleural plaques were seen in 4 patients (12%). The diagnostic rate was 100%. The complication rate was 6.1%: one case of mild pain and one of minor bleeding. No serious events occurred. The study had no comparison group. The authors concluded that the new pleuroscope can be operated safely and may improve the diagnostic rate. They noted the small, retrospective design, and said the diagnostic rate would have been lower with flat-type mesotheliomas.

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: Single-center retrospective analysis (review of medical records); no comparison group was studied
• Who was studied: 33 patients (10 women, 23 men; median age 74, range 24-90) with undiagnosed exudative pleural effusions, examined at the National Center for Global Health and Medicine, Tokyo, Japan, from December 2016 to March 2019
• Exposure: Not an asbestos exposure study. What was studied was a new flex-rigid pleuroscope (LTF-Y0032, Olympus), developed by the authors in association with Olympus, used under local anesthesia. It allows a maximum angle of curvature of 180° (versus 130° for the conventional LTF-240). No asbestos exposure histories are reported.
• Main results:
  • Observation at the introducer insertion site was possible in 32 of 33 cases (97%); in one case it was not possible due to hard adhesions
  • On pathology, 18 patients had malignant tumors and 15 had benign diseases
  • Malignant tumors included 10 pleural metastases of lung carcinoma (30.3%) and 4 malignant pleural mesotheliomas (12.1%), as well as 3 malignant lymphomas (9.2%) and 1 pleomorphic carcinoma (3%)
  • Benign diseases included two cases of asbestos-related pleurisy (6.1%), along with five pyothorax (15.1%), four nonspecific pleurisy (12.1%), three tuberculous pleurisy (9.1%) and one IgG-4 related disease (3%)
  • Pleural plaques were seen on the parietal pleura in 4 patients (12%); tumors and nodules were seen in 18 (55%)
  • The diagnostic rate was 100%
  • The complication rate was 6.1%, with no serious adverse events; minor complications were mild pain in one case and mild bleeding in one case
• The authors' conclusion: The authors concluded that the new pleuroscope can be operated safely and may improve the diagnostic rate, and that its improved bending angle is likely to minimize the blind area
• Limitations the authors state:
  • Retrospective review of medical records with a small sample size
  • The diagnostic rate would have been lower if there had been solid tumors or flat-type mesotheliomas
  • Procedures took longer than usual because the operability of the new pleuroscope and systems was being confirmed
  • The new pleuroscope still has limited operability compared with VATS

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Carcinoma, Empyema, Pleural Mesothelioma.

Related studies

• Flex-rigid pleuroscopy under local anesthesia in patients with dry pleural dissemination on radiography — Y. Watanabe, S. Sasada, et al. (2014)
• Rigid Mini-Thoracoscopy: The New Kid on the Block — E.O. Bedawi, N.M. Rahman (2020)
• Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions in Denmark — F. Willendrup, U. Bodtger, et al. (2014)
• Usefulness of new flex-rigid pleuroscopy in the diagnosis of malignant pleural mesothelioma — S. Ishii, Y. Ishii, et al. (2019)
• Dual-functIon Semi-rigid thoraCoscOpy Versus semi-rigid thoracoscopy for the diagnosis of plEuRal diseases: protocol for a multicentre, open-label, randomised controlled trial in China (DISCOVER-I) — M. Deng, X. Liu, et al. (2026)
• Diagnostic Utility of Pleural Fluid Cell Block versus Pleural Biopsy Collected by Flex-Rigid Pleuroscopy for Malignant Pleural Disease: A Single Center Retrospective Analysis — S. Miyoshi, S. Sasada, et al. (2016)

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