Value of autofluorescence in video-assisted thoracoscopic surgery in pleural diseases

Our plain-English summary of Value of autofluorescence in video-assisted thoracoscopic surgery in pleural diseases, by S.T. Liman, A. Elicora, S. Topcu, et al (The Thoracic and Cardiovascular Surgeon, 2013).

The study

• Authors: S.T. Liman, A. Elicora, S. Topcu, A.G. Akgul, S.S. Mehmetoglu, A. Ilgazli, C. Ercin, N. Etiler
• Journal: The Thoracic and Cardiovascular Surgeon
• Published: 2013;61(4):350-6
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Autofluorescence (AF) examination in thoracoscopy has not been used frequently. Here, our aim was to determine whether AF examination contributes additional information to white-light (WL) examination when attempting to detect malignant pleural lesions. We also liked to know whether the effectiveness of WL and AF-mode combination would be different for various pathologies or lesions of the pleura.

Methods: It is a retrospective study. Thirty-three patients with unexplained exudative pleural effusions underwent AF-assisted video-assisted thoracic surgery (VATS). Patients' data from the files were evaluated. In each case, the pleural cavity was thoroughly examined under WL alone and then in AF mode.

Results: The sensitivity and specificity of AF-assisted VATS for detecting malignant pleural lesions were 78.7 and 85%, respectively, and there were 21.3% false negatives. In the group with metastatic pleural disease, AF VATS correctly identified all lesions as AF positive, whereas sensitivity was lower for the group with malignant mesothelioma. Seven lesions, which were not diagnosed under WL, were detected in AF mode.

Conclusion: The overall sensitivity of AF-assisted VATS for detecting pleural malignancies was not satisfactory because of diagnostic errors in malignant mesothelioma. But it would be useful in detecting small malignant pleural lesions, which are not diagnosed under WL.

Georg Thieme Verlag KG Stuttgart · New York.

In plain English

This retrospective study from Kocaeli University Hospital in Turkey reviewed 33 patients with unexplained exudative pleural effusions who had video-assisted thoracoscopic surgery between February 2009 and May 2011. Surgeons first examined the pleura under ordinary white light, then in autofluorescence mode, an imaging setting in which suspicious tissue looks dark purple. Seven patients had malignant mesothelioma, five had metastatic pleural disease, and 21 had benign conditions. The article does not discuss asbestos exposure. Across 264 biopsies from 196 lesions, autofluorescence had a sensitivity of 78.7% and a specificity of 85% for malignancy. It flagged all biopsied metastatic nodules and thickenings as positive. In mesothelioma it flagged only 75.6% of nodule biopsies and 47.8% of pleural thickening biopsies. Autofluorescence found seven lesions in four patients that white light had missed, and all were malignant, but it did not change any patient's treatment. The authors concluded that malignant mesothelioma may give confusing autofluorescence results, though the method might help find small lesions not seen under white light.

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 review of patient records from a diagnostic imaging technique (autofluorescence-assisted video-assisted thoracoscopic surgery), checked against biopsy pathology
• Who was studied: 33 patients (23 men, 10 women; median age 55, range 22 to 77) with exudative pleural effusions that cytology could not diagnose. All had surgery at the Department of Thoracic Surgery, Kocaeli University Hospital, Turkey, between February 2009 and May 2011. Final diagnoses were malignant mesothelioma (7), metastatic pleural disease (5), chronic fibrinous pleuritis (16) and necrotizing granulomatous pleuritis, or tuberculosis (5).
• Exposure: No asbestos or other exposure was studied. The study evaluated autofluorescence imaging used alongside white-light examination during thoracoscopy.
• Main results:
  • 264 biopsies from 196 lesions were examined across the 33 patients
  • Across all biopsies, autofluorescence had a sensitivity of 78.7% and a specificity of 85% for detecting malignancy
  • In the metastatic pleural disease group, all biopsied nodules were autofluorescence positive (100% sensitivity). In the malignant mesothelioma group, sensitivity for nodules was 75.6%.
  • For pleural thickening biopsies overall, sensitivity was 68.4% and specificity 86.3%. The method detected 100% of metastatic malignant pleural thickenings but only 47.8% of malignant mesothelioma pleural thickenings.
  • In four patients, autofluorescence detected seven lesions that were not seen under white light, and all were malignant on pathology
  • Autofluorescence did not provide information that changed any patient's treatment in this series
• The authors' conclusion: The authors concluded that overall sensitivity was lower than in other reported series because of errors in malignant mesothelioma, which may give confusing autofluorescence results. They added that the technique might help find small lesions not seen under white light.
• Limitations the authors state:
  • The authors stated that autofluorescence thoracoscopy studies, including theirs, could not be compared effectively because patient numbers were small and few studies exist
  • The authors stated they could not compare their nodule versus pleural thickening results with the published literature, because no other series had used that classification

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: Video-Assisted Thoracoscopic Surgery (VATS), Thoracoscopy, Pleura, Pleural Effusion, Thoracic Surgery, Pleural Cavity, Malignant Mesothelioma.

Related studies

• Photodynamic diagnoses of malignant pleural diseases using the autofluorescence imaging system — M. Kitada, Y. Ohsaki, et al. (2014)
• Should all patients who have mesothelioma diagnosed by video-assisted thoracoscopic surgery have their intervention sites irradiated? — M. Nagendran, A. Pallis, et al. (2011)
• MesoTRAP: a feasibility study that includes a pilot clinical trial comparing video-assisted thoracoscopic partial pleurectomy decortication with indwelling pleural catheter in patients with trapped lung due to malignant pleural mesothelioma designed to address recruitment and randomisation uncertainties and sample size requirements for a phase III trial — C. Matthews, C. Freeman, et al. (2019)
• Video assisted thoracoscopic and open chest surgery in diagnosis and treatment of malignant pleural diseases — P. Perikleous, D.A. Waller (2017)
• The MesoVATS trial: is there a future for video-assisted thoracoscopic surgery partial pleurectomy? — R.C. Rintoul (2015)
• Video-assisted management of malignant pleural effusion in breast carcinoma — R. Gasparri, F. Leo, et al. (2006)

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