Thoracoscopy in the early diagnosis of malignant pleural effusions

Our plain-English summary of Thoracoscopy in the early diagnosis of malignant pleural effusions, by C. Boutin, P. Cargnino, J.R. Viallat (Endoscopy, 1980).

The study

• Authors: C. Boutin, P. Cargnino, J.R. Viallat
• Journal: Endoscopy
• Published: 1980;12(4):155-60
• Cited by: 38 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This article from Marseilles, France, described a new cold-light thoracoscope (a telescope passed into the chest to view the pleura and take biopsies) and the authors' results with it in pleural effusions, fluid around the lung. The authors had performed 239 thoracoscopies in 233 patients; 128 had a malignant pleural effusion (22 mesotheliomas, 106 metastatic tumors) and 8 a benign asbestos effusion. Since 1978, 45 cancer patients were examined with the new instrument. The authors' summary reported accurate tissue diagnosis in 43 (6 of 7 mesotheliomas, 37 of 38 metastatic tumors). The detailed results counted 39 thoracoscopic biopsies with one false negative; some patients were not biopsied because a needle biopsy was already positive. Cytology was positive in 24 per cent of cases and blind Abrams needle biopsy in 54 per cent. The one missed mesothelioma showed only pleural plaques on biopsy and was later found elsewhere at surgery. Small, probably early lesions were seen in only 4 of 128 patients. The authors concluded that thoracoscopy is the most efficient method of diagnosing cancer early when cytology or needle biopsy is negative.

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 clinical case series with a description of a new thoracoscope and technique
• Who was studied: 239 thoracoscopies in 233 patients at the Cancer Institute, Marseilles, France. 198 had chronic pleural effusion, and of these 128 had a malignant pleural effusion (22 mesotheliomas, 106 metastatic tumors). 45 cancer patients (7 mesotheliomas, 38 metastatic pleural tumors) were examined with the new cold-light thoracoscope from 1978 onward.
• Exposure: Not a study of asbestos exposure. The study examined a diagnostic procedure: thoracoscopy with a new cold-light thoracoscope, compared with cytology and Abrams needle biopsy. Asbestos is mentioned only for 8 patients with a benign asbestos effusion and for one mesothelioma patient with asbestos calcifications and pleural plaques.
• Main results:
  • In the authors' summary, an accurate histopathological diagnosis was found in 43 of the 45 cancer patients examined with the new thoracoscope: 6 of 7 mesotheliomas and 37 of 38 metastatic pleural tumors.
  • In the detailed results, only 32 of the 38 patients with pleural metastasis had thoracoscopic biopsies. The others had already had a positive Abrams needle biopsy and underwent thoracoscopy only for talc poudrage. The one negative metastatic biopsy was in a patient whose autopsy showed no pleural cancer, so the authors did not count it as a false negative.
  • With the new apparatus there was only one false negative result out of 39 biopsies in 45 thoracoscopies.
  • The Abrams needle biopsy was positive in 54 per cent of the authors' cases, and cytology in 24 per cent.
  • Looking at the pleural space alone suggested the diagnosis of malignancy in 93 per cent of cases.
  • In the one mesothelioma patient not diagnosed by thoracoscopy, asbestos calcifications were present on the diaphragm. Biopsies showed hyaline and calcified pleural plaques but no mesothelioma. A mesothelioma was later found in the apical pleura at thoracotomy.
  • Small, restricted and probably incipient lesions were seen in only 4 patients. In most patients, cancer involvement seen at thoracoscopy was very large. Very early diagnosis occurred in 4 of 128 patients.
  • Two mesothelioma patients with very small pinhead-like nodules survived 5 years and 3 months, and more than 4 years (still alive at the time of writing).
• The authors' conclusion: The authors concluded that thoracoscopy is the most efficient method of diagnosing a cancer at an early stage when cytology and/or closed needle biopsy are negative. They also stated that it is the most effective form of investigation for securing a diagnosis of cancer in pleural effusions.
• Limitations the authors state:
  • In most patients the lesions were already extensive at the time of thoracoscopy, so the authors said they could hardly claim that thoracoscopy achieves a very early diagnosis.
  • In 31 patients, thick adhesions prevented a full view of the pleura, and these patients were left out of the review of lesion extent.
  • In some cases the visual appearance was non-specific, so biopsies were needed for diagnosis.

Topics

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

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

Related studies

• Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial — M. Metintas, G. Ak, et al. (2010)
• Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions in Denmark — F. Willendrup, U. Bodtger, et al. (2014)
• Medical thoracoscopy in the diagnosis of unexplained pleural effusion — M.L. Wilsher, A.G. Veale (1998)
• Outcomes and complications following medical thoracoscopy — F.J. Brims, M. Arif, et al. (2012)
• Rigid Mini-Thoracoscopy: The New Kid on the Block — E.O. Bedawi, N.M. Rahman (2020)
• Investigation of pleural effusion: comparison between fibreoptic thoracoscopy, needle biopsy and cytology — W.M. Edmondstone (1990)

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