Ultrasound-guided medical thoracoscopy in the absence of pleural effusion

Our plain-English summary of Ultrasound-guided medical thoracoscopy in the absence of pleural effusion, by G. Marchetti, A. Valsecchi, D. Indellicati, et al (Chest, 2015).

The study

• Authors: G. Marchetti, A. Valsecchi, D. Indellicati, S. Arondi, M. Trigiani, V. Pinelli
• Journal: Chest
• Published: 2015;147(4):1008-1012
• Cited by: 59 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Medical thoracoscopy (MT) is a diagnostic and therapeutic procedure that permits the study of the pleural space. The presence of pleural adhesions is the most important contraindication to performing MT. Lesions of the pleura in absence of pleural effusion are usually studied in video-assisted thoracoscopic surgery (VATS) with preoperative ultrasound evaluation. No data are available about ultrasound-guided MT in the absence of pleural effusion.

Methods: From January 2007 to June 2013, 622 consecutive MTs were performed under ultrasound guidance without inducing a pneumothorax. A retrospective cohort of 29 patients affected by pleural diseases without fluid was reviewed. The fifth or sixth intercostal spaces along the midaxillary line with a good echographic "sliding sign" and normal appearance of the pleural line were chosen as the entry site. The pleural cavity was explored, and biopsies were performed.

Results: The mean age of the patient cohort was 62.8 years; there were 20 male patients and nine female patients. Pleural adherences were avoided, and adequate number of pleural biopsies were performed. No parenchymal lung injuries, bleeding, or hematoma occurred. Seventeen patients had a completely free pleural cavity, four patients had a single pleural adhesion, and eight had multiple pleural adhesions; in all cases, however, endoscopic exploration was possible and biopsy specimens were adequate. The most frequent histopathologic diagnosis was malignant pleural mesothelioma.

Conclusions: We have shown that thoracic ultrasound accurately identifies intrathoracic adhesions and, in experienced hands, can guide MT access, replacing the VATS approach, even in the complete absence of pleural effusion.

In plain English

This retrospective cohort study, from Brescia, Italy, looked back at 29 patients who had pleural disease but no pleural fluid. All had medical thoracoscopy, a camera examination of the space around the lungs, between January 2007 and June 2013, out of 622 consecutive thoracoscopies. The doctors first used chest ultrasound to choose an entry point where the lung was seen sliding normally against the chest wall, which they took to mean the lung was not stuck to it there. The patients were 20 men and 9 women, mean age 62.8 years. No lung injury, bleeding or hematoma occurred. Seventeen patients had no adhesions, four had one and eight had several, but examination and biopsy were possible in all. Malignant mesothelioma was diagnosed in 13 of the 29 patients. Other diagnoses were lung cancer (4), other tumors (5) and nonspecific chronic pleurisy (7). The article did not report asbestos exposure. The authors concluded that, in experienced hands, ultrasound can guide this procedure without pleural fluid, replacing surgery (VATS) in selected cases.

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 cohort study of a diagnostic procedure (ultrasound-guided medical thoracoscopy)
• Who was studied: 29 hospitalized patients (20 men, 9 women; mean age 62.8 years, SD 10.5) with pleural disease but no pleural effusion. They were selected from 622 consecutive medical thoracoscopies performed January 2007 to June 2013 at Spedali Civili di Brescia, Italy. The main indications were pleural thickening and pleural nodules or masses.
• Exposure: Not reported: the article studied a medical procedure and does not mention asbestos or any occupational exposure
• Main results:
  • In all 29 patients there were no lung injuries during the procedure and no bleeding or hematoma at the entry site
  • 17 patients (59%) had no pleural adhesions, 4 (14%) had a single adhesion away from the entry point, and 8 (27%) had multiple adhesions. In all cases examination was possible and biopsy specimens were adequate.
  • At least eight pleural biopsy specimens were collected from each patient
  • Diagnoses among the 29 patients: 13 malignant mesothelioma (44.8%), 4 metastatic bronchogenic carcinoma (lung cancer, 13.8%), 5 other tumors such as metastatic breast cancer (17.2%), and 7 nonspecific chronic pleurisy (24.1%)
  • Of the 13 mesotheliomas, 10 were epithelioid, 2 sarcomatoid and 1 biphasic
  • No pneumothorax occurred during the following days in hospital, and all drainage tubes were removed without complications
• The authors' conclusion: The authors concluded that thoracic ultrasound accurately identifies adhesions inside the chest and, in experienced hands, can guide medical thoracoscopy even with no pleural effusion. They believed that in selected cases it can safely replace the surgical VATS approach.

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: Ultrasound, Medical Thoracoscopy, Pleural Effusion, Pleura, Video-Assisted Thoracoscopic Surgery (VATS), Pneumothorax, Pleural Cavity, Biopsy.

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)
• Ultrasound-guided pneumothorax induction prior to local anaesthetic thoracoscopy — J.P. Corcoran, I. Psallidas, et al. (2015)
• Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma — R.F. Adams, W. Gray, et al. (2001)
• 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)
• First report of probe based confocal laser endomicroscopy during medical thoracoscopy — O. Bonhomme, B. Duysinx, et al. (2019)

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