Journal of Bronchology & Interventional Pulmonology

Our medical research library holds 11 studies published in Journal of Bronchology & Interventional Pulmonology (2009–2020). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 8 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it. For 1 study PubMed has no abstract for, we give the abstract printed in the article or, where there is none, a summary we wrote from it, each labeled as such.

About the journal

• Publisher: Wolters Kluwer Health/Lippincott Williams & Wilkins
• Published: 2009 to the present, United States
• Language: English
• ISSN: 1944-6586 (print), 1948-8270 (electronic)
• Continues: Journal of Bronchology
• Its record in the NLM Catalog

2020s

• Rigid Mini-Thoracoscopy: The New Kid on the Block. E.O. Bedawi, N.M. Rahman. 2020;27(3):157-159. Historical article PubMed · Publisher

  Summary

  This editorial commented on the MINT randomized controlled trial by Bansal and colleagues, which compared a new rigid mini-thoracoscope with semirigid thoracoscopy. The editorial's authors first reviewed the history of thoracoscopy. They noted that UK centres offering local anaesthetic thoracoscopy more than trebled from 11 to 37 between 1999 and 2009, and that case series reported diagnostic yields of 96% to 98.4%. They described the relative merits of rigid and semirigid instruments. Rigid instruments allowed larger, deeper biopsies, which the authors described as particularly important in diagnosing mesothelioma. Semirigid instruments offered easier handling. The new rigid mini-thoracoscope had a 5.5 mm endoscope with a 3.5 mm working channel. The single-centre MINT trial enrolled 73 patients with undiagnosed exudative pleural effusion. Diagnostic yield was 69.4% with the rigid mini-thoracoscope and 81.1% with semirigid thoracoscopy. Nonspecific pleuritis was frequent (29.7%), and a definitive diagnosis was reached in 67.6%. Patient-rated pain was significantly higher with the rigid mini-thoracoscope. The editorial's authors attributed the yield difference largely to the small sample size and noted possible effects of operator experience. They concluded that the device was not yet established but that the data would help plan larger studies. They suggested that the choice of instrument be guided by operator training and experience and by the local prevalence of conditions such as mesothelioma and tuberculosis.

  PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

2010s

• Intrapleural Urokinase Directly Under Medical Thoracoscopy for the Diagnosis of Malignant Pleural Mesothelioma With Severe Multiloculated Pleural Effusions. S. Terashita, H. Kawachi, S. Horikawa, et al. 2019;26(2):e26-e27. Case report PubMed · Publisher

• Prospective Study of the Utility of Computed Tomography Triage of Pleural Biopsy Strategies in Patients With Pleural Diseases. M. Metintas, G. Ak, S. Metintas, et al. 2019;26(3):210-218. PubMed · Publisher

  Abstract

  Background: This study aimed to prospectively evaluate the efficacy and reliability of a diagnostic workup, triaging pleural biopsy method according to baseline computerized tomography (CT) findings in the diagnosis of pleural diseases.

  Methods: Patients with pleural pathology were divided into 3 arms according to findings on CT scan images. Arm A: patients with pleural thickening/lesion in addition to pleural effusion. These patients underwent CT scan-guided Abrams' needle pleural biopsy. Arm B: patients with pleural effusion alone or suspected benign asbestos pleurisy. This group underwent medical thoracoscopy (MT). Arm C: patients with only pleural thickening. This group underwent ultrasonography-guided cutting needle pleural biopsy. MT was planned in patients who did not have a specific diagnosis in the CT scan-guided Abrams' needle pleural biopsy group. When patients with a histopathologic diagnosis of fibrinous pleuritis after MT were assessed in terms of the risk factors for malignant pleural diseases, we offered a further invasive procedure.

  Results: A total of 164 patients were enrolled in the study. Diagnostic sensitivity after the initial procedure was 90.2% in Arm A, 93.3% in Arm B, 95.2% in Arm C, and 92.4% in the entire workup. The negative predictive value of the entire workup was 90.4% for malignant pleural mesothelioma, 97.1% for metastatic malignant pleural diseases, and 100% for tuberculous pleurisy. Five cases who had a diagnosis of fibrinous pleuritis after MT were detected to have risk factors, 4 of which (80%) indicated malignant disease. Complication rates were low and acceptable.

  Conclusion: Use of CT scans to triage an appropriate pleural biopsy method is associated with high diagnostic success. We recommend that the proposed diagnostic workup in this study may be used as a diagnostic algorithm for pleural diseases that require a histopathologic analysis. Determination of risk factors predicting malignant disease in patients where fibrinous pleuritis is reported after MT would be useful for clinical practice.

• Endobronchial Diagnosis of a Malignant Mesothelioma. H.S. Yap, S. Klebe, A. Rose. 2016;23(3):e30-2. Case report · Letter PubMed · Publisher

• Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions in Denmark. F. Willendrup, U. Bodtger, S. Colella, et al. 2014;21(3):215-9. PubMed · Publisher

  Abstract

  Background: To assess the diagnostic accuracy and the safety of medical thoracoscopy (MT) performed with the semirigid thoracoscope.

  Methods: We retrospectively evaluated patients who underwent MT with semirigid thoracoscope under local anesthesia for unexplained exudative pleural effusion from March 1, 2009 to September 1, 2013 in Denmark.

  Results: Sixty-nine patients were retrospectively studied. In 13 patients it was not possible to perform the scheduled MT, in 9 cases due to an insufficient pneumothorax, in 3 due to an insufficient pleural effusion, and in 1 due to a purulent pleuritis. In 56 patients in whom MT was completed, the procedure was diagnostic in 44 cases: malignancy was reported in 26 patients and a benign diagnosis in 18. In the remaining 12 patients a definite diagnosis was not reached, and further testing was required.In an "intention-to-treat analysis" (69 patients in total), the diagnostic accuracy of MT was 63%, the sensitivity for malignancy was 59% [95% confidence interval (CI)=43%-73%], the specificity was 100% (95% CI=86%-100%), and the negative likelihood ratio was 0.41 (95% CI=0.29-0.58). Considering the 56 patients in whom it was possible to complete the procedure, the diagnostic accuracy was 78%, the sensitivity for malignancy was 74% (95% CI=54%-87%), the specificity was 100% (95% CI=83.75%-100%), and the negative likelihood ratio was 0.27 (95% CI=0.15%-0.45%). No mortality was reported.

  Conclusions: MT performed under local anesthesia with a semirigid scope is a simple and safe procedure with an acceptable sensitivity for malignancy.

• Pseudo-tumor mimicking indwelling pleural catheter tract metastasis in mesothelioma. R.L. Shrestha, B.A. Wood, Y.C. Lee. 2014;21(4):350-2. Case report PubMed · Publisher

  Abstract

  Patients with malignant mesothelioma are known to be at risk of developing needle tract metastasis from seeding of malignant cells at the pleural intervention site. Histologic confirmation of needle tract metastases is seldom sought. The diagnosis and management (often radiotherapy) are almost always based on clinical judgment of new subcutaneous lesions at prior pleural puncture sites in mesothelioma patients. We report 2 patients with mesothelioma who developed new subcutaneous nodules at their indwelling pleural catheter insertion site, mimicking tract metastases. Biopsies of both lesions revealed benign etiologies and both resolved without requiring irradiation. These cases remind clinicians that new subcutaneous lesions can be benign even when arising at pleural puncture sites of malignant pleural mesothelioma patients. Percutaneous biopsy can clarify the diagnosis in suitable cases.

• Desmoplastic malignant mesothelioma. A. Baççioğlu, E. Kaba, S.A. Ozmen, et al. 2013;20(2):155-8. Case report PubMed · Publisher

  Abstract

  Desmoplastic mesothelioma is a rare subtype of diffuse malignant mesothelioma. A 72-year-old woman from East Anatolia presented with chest pain. The images of body positron emission tomography revealed irregular, left pleural thickening involving mediastinal and diaphragmatic surfaces with hypermetabolic characterization. The diagnosis of desmoplastic malignant mesothelioma was confirmed by minithoracotomy and immunohistochemical staining with pan-cytokeratin, cytokeratin 5/6, calretinin, carcinoembryonic antigen, thyroid transcription factor-1, CD15, and HMB-45 on the biopsy specimen. This case is unique in terms of the reporting patient being from a nonendemic area for asbestos-related diseases and in terms of its rare histopathology.

• Pleuroscopic punch biopsy using insulated-tip diathermic knife-2 for the diagnosis of desmoplastic malignant mesothelioma. K. Masai, S. Sasada, T. Izumo, et al. 2013;20(4):345-8. Case report · Review PubMed · Publisher

  Abstract

  Desmoplastic malignant mesothelioma (DMM) is a rare subtype of malignant pleural mesothelioma (MPM) and is often difficult to distinguish from pleural fibrosis and reactive mesothelial hyperplasia, especially if the biopsy samples are small. We performed full-thickness pleural biopsy on a lesion suspected to be DMM using an insulated-tip diathermic knife-2 (IT knife-2) during flex-rigid pleuroscopy. IT knife-2 is a novel electrosurgical device for endoscopic submucosal dissection in the early gastrointestinal cancer. It consists of a needle knife with 3 short blades at the distal end attached to an insulated ceramic tip. A 54-year-old man presenting with chest wall mass and thickened pleura, in whom a computed tomography-guided percutaneous needle aspiration had remained negative, underwent flex-rigid pleuroscopy for definitive diagnosis. While applying electric current, we used the IT knife-2 to incise the pleura in a circular shape just above the endothoracic fascia. The incised pleura was removed by forceps and examined pathologically. The microscopic examination was compatible with DMM. We discovered that pleuroscopic punch biopsy using IT knife-2 can diagnose DMM. Use of IT knife-2 during flex-rigid pleuroscopy can obtain sufficient samples from densely thickened pleura, which is difficult to diagnose with small biopsies.

• The safety of medical thoracoscopy in a group at high risk for complications. M. Metintas, G. Ak, H. Yildirim, et al. 2013;20(3):224-31. PubMed · Publisher

  Abstract

  Background: The use of medical thoracoscopy (MT) for the diagnosis and/or palliative treatment of pleural effusions is expected to become more widespread in the coming years. The aims of the present study were to establish the safety of MT in a group of patients at high risk for complications and to determine the factors that affect the development of complications.

  Methods: A total of 355 patients who underwent MT were divided into 2 groups: patients at high risk for complications and patients who had no risk factor. After the procedure, the complications of MT were recorded. All patients were followed up for at least 24 months. To evaluate the relationship between variables and complications, logistic regression models were applied.

  Results: Of the 355 patients, 106 had one or more risk factors, whereas 249 did not have any risk factor. Pain (12.3%) was the most frequent complication in the high-risk patients, and subcutaneous emphysema (10.3%) was the most frequently reported complication in the normal-risk patients. Only pain was observed more frequently in the high-risk patients compared with the normal-risk patients. Talc pleurodesis was associated with prolonged air leak (8.3%) and empyema (5%). The percentage of patients with no complication was 58.6%. The mortality rate was 0.28%. In the multivariate analysis, the presence of mesothelioma was identified as a factor that increased the risk of complication.

  Conclusions: MT is a safe method for the diagnosis of patients with pleural effusion, even in patients at high risk for complications. However, complications, found in approximately half of the patients, should also be examined in terms of cost.

• Mesothelioma: a soon to be forgotten disease in the United States?. D. Thomas, R. Geck, D. Rozas, et al. 2012;19(3):258-61. Case report PubMed · Publisher

  Abstract

  Malignant pleural mesothelioma is an uncommon cancer that commonly presents with a large unilateral bloody pleural effusion long after asbestos exposure. Its prevalence is decreasing with the decreasing exposure to asbestos in the United States. We present a patient with malignant pleural mesothelioma who underwent evaluation and treatment during medical thoracoscopy. The thoracoscopic evaluation revealed multiple, varied, and severe but characteristic findings of malignant pleural mesothelioma. Medical thoracoscopy is the procedure of choice for the diagnosis of pleural mesothelioma.

2000s

• Minimally invasive talc insufflation: a new technique with no need for thoracoscopy. M.R. Khoshnevis, R. Geis. 2009;16(2):99-101. PubMed · Publisher

  Abstract

  Talc insufflation is usually performed by thoracic surgeons in the operating room through video-assisted thoracoscopic surgery (VATS) or by pulmonologists in a specially equipped suite (medical thoracoscopy). These techniques can cause postoperative pain, require placement of port sites through small incisions, and increase waiting time and cost for patients who have no need for visual inspection of the pleura, biopsy, or apical bleb resection. Poudrage (French for powdering) with asbestos-free talcum powder (talc) is a proven technique with wide acceptance for treatment of pneumothorax. Use of a small, 4 g, canister of talc under pressure is a commonly used method to aerosolize and apply it using the supplied Teflon catheters. This report describes a patient who was too ill for almost any formal procedure in whom we performed talc poudrage by an even less invasive technique, using controlled permissive pneumothorax in the radiology suite by using a small needle, guide wire, and dilator with no thoracoscopy ports. Given the increased expense, frequent waiting time delay, and diminished access to care, we believe this technique deserves consideration in patients who are poor surgical candidates and perhaps in the young patient with no computed tomography evidence that might suggest the need for apical bleb resection, biopsy, or additional investigation.

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