Semirigid thoracoscopy: an effective method for diagnosing pleural malignancies

Our plain-English summary of Semirigid thoracoscopy: an effective method for diagnosing pleural malignancies, by A. Rozman, L. Camlek, I. Kern, et al (Radiology and Oncology, 2014).

The study

• Authors: A. Rozman, L. Camlek, I. Kern, M.M. Malovrh
• Journal: Radiology and Oncology
• Published: 2014;48(1):67-71
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Thoracoscopy with a semirigid instrument is a recent technique for diagnosing pleural diseases. The purpose of this study was to report diagnostic yield and complications of the method.

Patients And Methods: Patients with pleural effusion of unknown origin and/or pleural irregularities suspicious for pleural malignancy were included after less invasive means of diagnosis had failed. All procedures were performed under local anaesthesia with intravenous sedation/analgesia with a single point of entry with a semirigid thoracoscope (Olympus LTF-160). Data were collected prospectively between 2008 and 2012.

Results: One hundred fifteen thoracoscopies were performed on 111 patients. The median age was 65 years (range 28-86 years), 14.4% were female and 85.6% male. Seventy-three (65.8%) patients had malignant pleural disease (malignant mesothelioma, metastatic cancer) and 38 (34.2%) had benign disease. The sensitivity, negative predictive value, and accuracy of the procedure for malignancy were 96.0%, 93.0%, and 97.4% respectively. Pleurodesis was carried out in 34 patients; in 32 (94.1%) it was assessed as successful after 1 month. There were 24 adverse events: three empyemas/pleural infections, three bronchopleural fistulae after chest tube placement and lung re-expansion, five patients had excessive pain after pleurodesis, six patients had sedation-associated hypotension, and seven patients had self-limited fever after plerodesis. One patient died 11 days after a procedure for advanced carcinoma.

Conclusions: Semirigid thoracoscopy is an accurate and safe method for evaluation of pleural diseases and useful for therapeutic talc pleurodesis.

In plain English

This single-centre prospective study in Slovenia reported how well semirigid thoracoscopy diagnosed disease of the pleura (the lining around the lungs). Semirigid thoracoscopy is a camera procedure done through one opening in the chest, under local anaesthesia and sedation. Between 2008 and 2012, 115 procedures were performed on 111 adults whose fluid around one lung or suspicious pleural changes remained unexplained after less invasive tests. Of these patients, 36 (32.4%) had asbestos exposure. Of the 111 patients, 73 (65.8%) had malignant disease, including 48 with mesothelioma and 24 with secondary carcinoma. Another 38 had benign disease, including 12 with asbestos pleuritis. For malignancy, overall accuracy was 97.4%, sensitivity 96.0%, positive predictive value 100% and negative predictive value 93.0%. Talc pleurodesis was assessed as successful after one month in 32 of 34 patients. There were six serious adverse events in four patients and 18 minor ones. One patient died 11 days after a procedure for advanced carcinoma. The authors concluded the method was effective and safe. They noted weak, bendable biopsy forceps and called for studies comparing it with rigid thoracoscopy.

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-centre study with prospectively collected data (case series of semirigid thoracoscopy procedures, descriptive statistics)
• Who was studied: 111 patients (115 procedures) aged at least 18, median age 65 (range 28 to 86), at University Clinic Golnik, Slovenia, 2008 to 2012, with unilateral pleural effusion of unknown origin and/or pleural irregularities suspicious for malignancy after less invasive diagnosis failed. Of 123 referred, 12 (9.8%) could not have pneumothorax induced because of fibrothorax or extensive adhesions.
• Exposure: The study evaluated a diagnostic procedure, semirigid thoracoscopy (Olympus LTF-160), not an exposure. Asbestos exposure was recorded as yes in 36 (32.4%) of the 111 patients. No fiber types or doses were reported, and results were not analysed by exposure.
• Main results:
  • Of 111 patients, 73 (65.8%) had malignant disease: 48 mesothelioma, 24 secondary carcinoma, 1 lymphoma
  • Among the 38 patients with benign disease, 12 had asbestos pleuritis (others: 20 non-specific pleuritis, 2 tuberculous pleuritis, 1 rheumatoid pleurisy, 1 hemothorax)
  • For malignancy: overall diagnostic accuracy 97.4%, sensitivity 96.0%, positive predictive value 100%, negative predictive value 93.0%
  • Of 34 patients who had talc pleurodesis, 32 (94.1%) were assessed as successful after 1 month
  • Six serious adverse events occurred in four patients
  • There were 18 minor complications (including 7 cases of transient fever, 5 needing additional analgesia after talc poudrage, 6 with sedation-associated hypotension)
  • One patient died 11 days after a procedure for advanced carcinoma
  • In 12 of 123 referred patients (9.8%), pneumothorax could not be induced because of fibrothorax or extensive adhesions
• The authors' conclusion: The authors concluded that semirigid thoracoscopy is an effective and safe method for diagnosing and, to some extent, treating pleural disorders, and that further studies comparing rigid and semirigid thoracoscopy are needed
• Limitations the authors state:
  • The authors stated that the level of evidence for the semirigid instrument is still limited compared with rigid thoracoscopy, and that a large multicentre randomized study would be needed to establish non-inferiority
  • The authors noted possible disadvantages: a narrow working channel and weak, bendable biopsy forceps that could slow the biopsy process

Topics

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

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