Ultrasound-guided pneumothorax induction prior to local anaesthetic thoracoscopy

Our plain-English summary of Ultrasound-guided pneumothorax induction prior to local anaesthetic thoracoscopy, by J.P. Corcoran, I. Psallidas, R.J. Hallifax, et al (Thorax, 2015).

The study

• Authors: J.P. Corcoran, I. Psallidas, R.J. Hallifax, A. Talwar, A. Sykes, N.M. Rahman
• Journal: Thorax
• Published: 2015;70(9):906-8
• Cited by: 36 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Local anaesthetic thoracoscopy (LAT) is performed by a growing number of respiratory physicians in the context of an expanding population with pleural disease. Most LATs occur in patients with moderate to large effusions where the presence of fluid allows safe access to the pleural space. Patients with little or no fluid, but other features concerning for pleural disease, are usually investigated by surgical means. Advanced LAT practitioners can also provide this service through pneumothorax induction, although there is little published data on the safety or efficacy of this technique. We present data from a series of 77 consecutive patients in whom ultrasound-guided pneumothorax induction and LAT were attempted. 67 procedures (87.0%) were successful, with the most common histopathological diagnoses being chronic pleuritis (58.2%) and mesothelioma (16.4%). No adverse events were reported secondary to the procedure. These findings demonstrate the utility of this approach and should inform future practice and guidelines.

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In plain English

This was a review of clinical practice at the Oxford Pleural Unit, UK. It concerned local anaesthetic thoracoscopy, in which a camera is passed into the chest to examine and biopsy the pleura (the lining around the lung). This normally needs fluid around the lung for safe entry. Patients with little or no fluid are usually investigated surgically, but advanced practitioners can instead first let air into the chest (a pneumothorax) using an ultrasound-guided needle. Of 207 thoracoscopies attempted from July 2011 to June 2014, 77 needed this step. It succeeded in 67 of the 77 patients (87.0%). Among those 67 patients, biopsies most often showed chronic pleuritis or fibrosis (39, 58.2%). Cancer was found in 22 (32.8%), including 11 (16.4%) with mesothelioma. Seven of the 10 failures had limited or poor lung sliding on ultrasound. No lung injury or other complication from the needle or pneumothorax was reported. The authors concluded the technique was feasible and safe in experienced hands, in what they called a single-centre study with limited numbers. The article does not discuss asbestos or exposure histories.

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 single-centre case series (review of clinical practice using records and a prospectively collected procedural database)
• Who was studied: 77 consecutive patients being investigated for pleural disease who had little or no pleural fluid and needed pneumothorax induction, out of 207 local anaesthetic thoracoscopies attempted at the Oxford Pleural Unit, UK, July 2011 to June 2014. 53 were male; mean age was 67.8 years.
• Exposure: Not an asbestos exposure study. What was studied was a procedure: ultrasound-guided pneumothorax induction with a 16-gauge Boutin needle before local anaesthetic thoracoscopy, an approach the authors describe as advanced (level 2) practice for patients with little or no pleural fluid, who are usually investigated surgically. No asbestos exposure information is reported.
• Main results:
  • Pneumothorax induction succeeded, allowing thoracoscopy to go ahead, in 67 of 77 patients (87.0%)
  • Among the 67 patients with a successful thoracoscopy, the most common biopsy diagnosis was non-specific chronic pleuritis or fibrosis: 39 (58.2%)
  • Among the 67 patients with a successful thoracoscopy, 22 (32.8%) had malignant disease, of whom 11 (16.4% of the 67) had mesothelioma (all subtypes)
  • 47 of the 67 patients with a successful thoracoscopy (70.1%) were discharged the same day
  • Of the 10 patients in whom a pneumothorax could not be induced, 7 had limited or poor lung sliding on ultrasound suggesting pleural adhesions
  • Of the failed cases, six patients were switched during the procedure to ultrasound-guided needle biopsies, all of which gave a diagnosis; four were referred for surgical biopsies
  • Of the 70 patients with clear lung sliding on ultrasound, 67 (95.7%) had successful lung collapse
  • No patient had a lung injury or other complication directly related to needle insertion or pneumothorax formation
• The authors' conclusion: The authors concluded that ultrasound-guided pneumothorax induction is feasible and safe when performed by experienced thoracoscopy practitioners using an in-plane ultrasound approach
• Limitations the authors state:
  • Single-centre study with limited numbers

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, Pneumothorax, Thoracoscopy, Mesothelioma.

Related studies

• Physician-based ultrasound-guided biopsy for diagnosing pleural disease — R.J. Hallifax, J.P. Corcoran, et al. (2014)
• Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma — M. Sperandeo, L. Dimitri, et al. (2014)
• Flex-rigid pleuroscopy under local anesthesia in patients with dry pleural dissemination on radiography — Y. Watanabe, S. Sasada, et al. (2014)
• Ultrasound-guided medical thoracoscopy in the absence of pleural effusion — G. Marchetti, A. Valsecchi, et al. (2015)
• The role of endobronchial ultrasound guided transbronchial needle aspiration cytology in the investigation of mediastinal lymphadenopathy and masses, the North Tees experience — S. Natu, J. Hoffman, et al. (2010)
• 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)

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