The Portsmouth thoracoscopy experience, an evaluation of service by retrospective case note analysis

Our plain-English summary of The Portsmouth thoracoscopy experience, an evaluation of service by retrospective case note analysis, by S.V. Fletcher, R.J. Clark (Respiratory Medicine, 2007).

The study

• Authors: S.V. Fletcher, R.J. Clark
• Journal: Respiratory Medicine
• Published: 2007;101(5):1021-5
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Occupational asbestos exposure has been endemic in Portsmouth. A retrospective case note analysis of 50 patients who underwent thoracoscopy over a 2-year period from January 2003 was undertaken. Biopsies were taken in 47 cases, 31 of which showed malignant mesothelioma. Thirty seven percent of those without a history of direct exposure to asbestos had mesothelioma, implying that even in the absence of an exposure history a low threshold for investigation should be adopted for the local population. There was no mortality or significant morbidity associated with the procedure. Medical thoracoscopy is safe and effective in the diagnosis of benign and malignant pleural disease particularly in this high risk population.

In plain English

This was a retrospective review of case notes at the Queen Alexandra Hospital in Portsmouth, UK. The authors describe the area as having endemic occupational asbestos exposure because of the nearby Dockyards. They randomly selected 50 patients from 79 medical thoracoscopies (examinations of the chest lining under local anaesthetic) done from January 2003 to December 2005. Of the 50, 43 were men. Twenty-nine had documented asbestos exposure, based on recalled direct exposure and high-risk jobs such as pipe lagging, Dockyard work or Naval stoker. No asbestos fiber types were reported. Biopsies were taken in 47 patients, and 31 were diagnosed with malignant mesothelioma. Mesothelioma was found in 23 of the 29 exposed patients and in 8 without recorded exposure (reported as 37% of that group). The authors say patients with positive fluid cytology were selected out, yet cytology had suggested mesothelioma beforehand in 3 of the 31 mesothelioma cases. Nine of 50 patients (18%) had a complication; no deaths were attributed to the procedure. The authors acknowledged selection bias and concluded the procedure was safe and effective in this population.

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: retrospective case note analysis (service evaluation) at a single hospital
• Who was studied: 50 patients randomly selected from the 79 medical thoracoscopies performed at Queen Alexandra Hospital, Portsmouth, UK, between 1 January 2003 and 31 December 2005; 43 men and 7 women; mean age 72 (range 49 to 84); 45 had a smoking history
• Exposure: Asbestos exposure as recorded in the case notes: the patient's documented recollection of direct exposure, linked by a garbled symbol in the text to a high-risk occupation such as pipe lagging, Dockyard work or work as a Naval stoker. 29 of 50 patients had documented exposure. No fiber types or doses were reported.
• Main results:
  • Among all 50 patients, biopsies were taken in 47, and 31 showed malignant mesothelioma
  • Among the 29 patients with documented asbestos exposure, 23 (shown as 80%) had mesothelioma on histology
  • Among patients without documented asbestos exposure, 8 had mesothelioma (Figure 2). The article reports this as 37%. With 21 unexposed patients (50 minus 29, matching the Figure 2 counts), it works out to about 38%.
  • Among the 31 mesothelioma cases, pleural fluid cytology before the procedure was positive, defined as highly suggestive of mesothelioma, in 3. This gave a sensitivity of 3/31 and a specificity of 100%. The authors state that patients with positive cytology from simple aspiration were selected out of the thoracoscopy population, although these 3 cases were included.
  • Among all 50 patients, 9 (18%) had some form of complication
  • Five patients had failure of lung re-expansion ('trapped lung'), all in the context of mesothelioma
  • No deaths were directly attributed to the procedure. One 81-year-old man died 3 days after thoracoscopy from renal failure associated with his metastatic prostate cancer.
• The authors' conclusion: The authors concluded that in this region, where occupational asbestos exposure is endemic, medical thoracoscopy is safe and effective in diagnosing benign and malignant pleural disease. They added that a low threshold of suspicion for pleural malignancy is warranted in this population even without a history of asbestos exposure.
• Limitations the authors state:
  • Selection bias toward patients with known malignancy or a high pre-test probability of malignancy, particularly mesothelioma
  • Strict criteria for asbestos exposure may partly explain why mesothelioma was found in patients without recorded exposure
  • Only 50 of the 79 thoracoscopies were included because of study constraints

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Thoracoscopy, Asbestos Exposure, Endemic, Malignant Mesothelioma, Mesothelioma, Exposure History, Medical Thoracoscopy.

Related studies

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• Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience — J. Leemans, C. Dooms, et al. (2018)
• Diagnostic value of medical thoracoscopy in pleural disease: a 6-year retrospective study — F.X. Blanc, K. Atassi, et al. (2002)
• Outcomes and complications following medical thoracoscopy — F.J. Brims, M. Arif, et al. (2012)
• Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center: a collaborative medical-surgical initiative — Z.S. DePew, D. Wigle, et al. (2014)
• Medical thoracoscopy in the diagnosis of unexplained pleural effusion — M.L. Wilsher, A.G. Veale (1998)

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