Advances in pleuroscopy

Our plain-English summary of Advances in pleuroscopy, by S. Anevlavis, M.E. Froudarakis (The Clinical Respiratory Journal, 2018).

The study

• Authors: S. Anevlavis, M.E. Froudarakis
• Journal: The Clinical Respiratory Journal
• Published: 2018;12(3):839-847
• Type of article: Review
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: To describe the technique of pleuroscopy, its clinical uses such as diagnosis of exudative pleural effusion, treatment of pleural infection, treatment of pneumothorax, and diagnosis and pleurodesis of malignant pleural mesothelioma. Also to describe the newer techniques developed such as minothoracoscopy, semirigid thoracoscopy, narrow band imaging pleuroscopy, infrared pleuroscopy, autofluorescence pleuroscopy.

Data Source: We searched the pubmed the last decade for publications with the key words pleuroscopy, medical thoracoscopy, pneumothorax and pleuroscopy, malignant pleural mesothelioma, minothoracoscopy, semirigid thoracoscopy, autofluorescence pleuroscopy.

Conclusion: Medical thoracoscopy is the method of choice for investigation of the undiagnosed exudative pleural effusions. Newer techniques, such as narrow band imaging thoracoscopy, infrared thoracoscopy, autofluorescence thoracoscopy are offering a promising future for medical thoracoscopy.

© 2017 John Wiley & Sons Ltd.

In plain English

This article was a narrative review, not a new study. The authors searched PubMed for publications from the previous decade on pleuroscopy (also called medical thoracoscopy), a procedure in which a lung specialist looks inside the chest space around the lung through a small opening and takes tissue samples. The review covered diagnosis of fluid around the lung, treatment of pleural infection and collapsed lung, talc pleurodesis, and newer instruments and imaging methods. On malignant pleural mesothelioma, the authors wrote that thoracoscopy is the best method to obtain the diagnosis and that its diagnostic yield is above 90%. They cited an earlier study of 188 mesothelioma patients by Boutin and Rey. In that study, thoracoscopy reached a diagnosis in 98%, compared with 26% for fluid cytology, 21% for needle biopsy and 39% for the two combined. The review described the talc used for pleurodesis as asbestos-free and did not study asbestos exposure. The authors concluded that medical thoracoscopy is the method of choice for investigating undiagnosed exudative pleural effusions.

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: Narrative review of published literature on pleuroscopy (medical thoracoscopy)
• Who was studied: No patients were studied directly. The authors reviewed PubMed publications from the previous decade on pleuroscopy, medical thoracoscopy, pneumothorax, malignant pleural mesothelioma and newer thoracoscopy techniques.
• Main results:
  • The authors stated that thoracoscopy is the best method to obtain the diagnosis of malignant pleural mesothelioma when it is suspected on clinical or radiological grounds.
  • The authors reported that the diagnostic yield of thoracoscopy in malignant pleural mesothelioma is above 90%.
  • In a cited earlier study by Boutin and Rey of 188 patients with malignant pleural mesothelioma, diagnosis was achieved by fluid cytology in 26%, needle biopsy in 21%, fluid cytology and needle biopsy combined in 39%, and thoracoscopy in 98%.
  • Citing guidelines, the review reported that the diagnostic yield of cytological examination (testing the fluid) for malignant pleural mesothelioma varies from 4 to 77%.
  • In a cited study by Levallet and collaborators of 157 patients with malignant pleural mesothelioma, patients whose c-MET was located only in the plasma membrane had a median overall survival of 25 months, compared with 13 months for the rest of the patients.
  • The review described thoracoscopic talc poudrage using large-particle, calibrated, asbestos-free talc as the gold standard for pleurodesis in patients with malignant pleural effusion.
  • A cited meta-analysis by Agarwal and colleagues (17 studies, 755 patients) reported that the semirigid pleuroscope had a sensitivity of 91% and a specificity of 100% for diagnosing exudative pleural effusions.
• The authors' conclusion: The authors concluded that medical thoracoscopy is the method of choice for investigating undiagnosed exudative pleural effusions. They also concluded that newer techniques, such as narrow band imaging, infrared and autofluorescence thoracoscopy, offer a promising future for the procedure.

Topics

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

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

Related studies

• Flex-rigid pleuroscopy under local anesthesia in patients with dry pleural dissemination on radiography — Y. Watanabe, S. Sasada, et al. (2014)
• First report of probe based confocal laser endomicroscopy during medical thoracoscopy — O. Bonhomme, B. Duysinx, et al. (2019)
• Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience — J. Leemans, C. Dooms, et al. (2018)
• A randomized controlled trial of the efficacy of cosmetic talc compared with iodopovidone for chemical pleurodesis — R. Agarwal, A.S. Paul, et al. (2011)
• Talc Pleurodesis: A Medical, Medicolegal, and Socioeconomic Review — I. Baiu, E. Yevudza, et al. (2020)
• The safety of medical thoracoscopy in a group at high risk for complications — M. Metintas, G. Ak, et al. (2013)

Browse more research in The Clinical Respiratory Journal, or return to medical research.