Flex-rigid pleuroscopy under local anesthesia in patients with dry pleural dissemination on radiography

Our plain-English summary of Flex-rigid pleuroscopy under local anesthesia in patients with dry pleural dissemination on radiography, by Y. Watanabe, S. Sasada, C. Chavez, et al (Japanese Journal of Clinical Oncology, 2014).

The study

• Authors: Y. Watanabe, S. Sasada, C. Chavez, Y. Matsumoto, T. Izumo, T. Tsuchida
• Journal: Japanese Journal of Clinical Oncology
• Published: 2014;44(8):749-55
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Medical thoracoscopy using a flex-rigid pleuroscope under local anesthesia is a recent diagnostic procedure for malignant pleural disease. Although most previous studies have reported its usefulness, especially in wet pleural dissemination, the feasibility of flex-rigid pleuroscopy in patients with dry pleural dissemination is not well established.We assessed the diagnostic performance of flex-rigid pleuroscopy under local anesthesia in patients suspected of dry pleural dissemination on radiography.

Methods: The pleuroscopic parameters of all patients (n = 56) who underwent flex-rigid pleuroscopy at the National Cancer Center Hospital from October 2011 to September 2013 were retrospectively reviewed. Those with computed tomography findings of asymmetric pleural thickening or pleural nodules without pleural effusion (dry group, n = 16) were compared with the remaining patients with pleural effusion (wet group).

Results: The dry group consisted of eight men and eight women, with a median age of 61 years (range, 48-79 years). The definitive diagnoses were adenocarcinoma (n = 10), mesothelioma (n = 2) and chronic inflammation (n = 3). The diagnostic accuracy was 93.8% (15/16). Only two minor complications were observed: mild chest pain (n = 1) and transient hypoxia (n = 1). No major complications such as pneumothorax were observed. The mean duration of post-operative chest tube drainage in the dry group was 2.31 ± 2.26 days. Complications, operation duration and diagnostic accuracy did not statistically differ between the two groups.

Conclusions: Flex-rigid pleuroscopy under local anesthesia can be a well-tolerated diagnostic procedure for radiographic dry pleural dissemination with respect to diagnostic yield and complications.

© The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: [email protected].

In plain English

This single-center retrospective study reviewed 56 patients who had flex-rigid pleuroscopy (viewing and sampling the chest lining through a small cut) under local anesthesia at the National Cancer Center Hospital in Tokyo, Japan, between October 2011 and September 2013. Sixteen patients had pleural thickening or nodules on CT scans with no fluid around the lung (the dry group). Forty had pleural fluid (the wet group). In the dry group, the procedure gave a definitive diagnosis in 15 of 16 patients (93.8%): lung adenocarcinoma in 10, malignant mesothelioma in 2 and chronic inflammation in 3. The remaining patient was suspected of malignant pleural mesothelioma and was diagnosed with it after a second biopsy under general anesthesia. Two dry-group patients had minor complications, transient hypoxia (a brief drop in oxygen) and mild chest pain, and none had major complications. Diagnostic accuracy, operation time and complications did not differ statistically between the dry and wet groups. The authors concluded the procedure can be well tolerated for suspected dry pleural dissemination. They noted their study was retrospective and small. The article did not report patients' asbestos exposure.

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 study comparing patients without pleural effusion (dry group) to patients with pleural effusion (wet group)
• Who was studied: 56 patients suspected of pleural dissemination who underwent flex-rigid pleuroscopy at the National Cancer Center Hospital, Tokyo, Japan, from October 2011 to September 2013. 16 had no pleural effusion on CT (dry group) and 40 had pleural effusion (wet group).
• Main results:
  • In the dry group, the overall diagnostic accuracy was 93.8% (15/16).
  • Definitive diagnoses in the dry group (n = 16): lung adenocarcinoma 10 (63%), malignant mesothelioma 2 (13%), chronic inflammation 3 (19%).
  • One further dry-group patient, suspected of malignant pleural mesothelioma, had a pleural re-biopsy under general anesthesia and was given a definitive diagnosis of malignant pleural mesothelioma.
  • In the dry group, two patients had minor complications (transient hypoxia and mild chest pain). There were no major complications such as intrathoracic hemorrhage, re-expansion pulmonary edema or procedure-related death.
  • Compared with the wet group, the dry group did not differ statistically in diagnostic accuracy (15 of 16 vs 39 of 40 successful, P = 0.49), operation duration (mean 55.3 plus or minus 15.4 min vs 58.2 plus or minus 15.9 min, P = 0.54) or complications (2 of 16 vs 5 of 40, P = 0.66).
  • In the dry group, the chest tube drained for a mean of 2.31 plus or minus 2.26 days, and in 69% (11/16) the tube was removed on post-operative Day 1.
  • Adding the insulated-tip diathermic knife (IT-2) to standard flexible forceps was superior to forceps alone in 3 of 16 dry-group patients (malignant pleural mesothelioma in 2 and chronic inflammation in 1).
  • Of 13 dry-group patients who had pre-operative PET-CT, FDG uptake of pleura or pleural nodules was detected in only 2.
• The authors' conclusion: The authors concluded that flex-rigid pleuroscopy under local anesthesia can be a well-tolerated diagnostic procedure for radiographically suspected dry pleural dissemination, with respect to diagnostic yield and complication rates.
• Limitations the authors state:
  • Retrospective design and small sample size; the authors stated that larger studies of patients without pleural effusion are needed.

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: Medical Thoracoscopy, Pleural Thickening, Pleural Effusion, Adenocarcinoma, Mesothelioma, Chronic Inflammation, Hypoxia, Pneumothorax.

Related studies

• Cryobiopsy during flex-rigid pleuroscopy: an emerging alternative biopsy method in malignant pleural mesothelioma. A comparative study of pathology — T. Nakai, Y. Matsumoto, et al. (2019)
• Ultrasound-guided pneumothorax induction prior to local anaesthetic thoracoscopy — J.P. Corcoran, I. Psallidas, et al. (2015)
• Advances in pleuroscopy — S. Anevlavis, M.E. Froudarakis (2018)
• Semi-Rigid Thoracoscopic Punch Biopsy Using a Hybrid Knife with a High-Pressure Water Jet for the Diagnosis of Pleural Effusions — Y. Yin, R. Eberhardt, et al. (2016)
• 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)

Browse more research in Japanese Journal of Clinical Oncology, or return to medical research.