Medical thoracoscopy without pleural fluid: How I do it

Tamburrini, Mario; Desai, Unnati; Fanti, Giovanni; Scarda, Angelo; Zampieri, Fabio; Zuccon, Umberto; Thakare, Parikshit; Contoli, Marco; Papi, Alberto

doi:10.4081/monaldi.2021.1331

Cited by 2 publications

(2 citation statements)

References 7 publications

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“…Thoracoscopy is considered as the gold standard biopsy technique for the diagnosis of MPM. However, dry circumferential pleural thickening without PE might cause the cavity to be inaccessible and thoracoscopy unfeasible [14]. Furthermore, general clinical conditions coupled with the burden of comorbidities in patients with thoracic malignancies may represent a major contraindication for such a diagnostic approach [15,16].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Ultrasound Guided Percutaneous Pleural Needle Biopsy for Malignant Pleural Mesothelioma

Iadevaia,

D’Agnano,

Pagliaro

et al. 2024

JCM

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Background/Objectives: Ultrasound (US) has been progressively spreading as the most useful technique for guiding biopsies and fine-needle aspirations that are performed percutaneously. Malignant pleural mesothelioma (MPM) represents the most common malignant pleural tumour. Thoracoscopy represents the gold standard for diagnosis, although conditions hampering such diagnostic approach often coexist. The Objective was to determine whether ultrasound-guided percutaneous needle biopsy (US-PPNB) has a high diagnostic accuracy and represents a safe option for diagnosis of MPM. Methods: US-PPNB of pleural lesions suspected for MPM in patients admitted from January 2021 to June 2023 have been retrospectively analyzed. An 18-gauge semi-automatic spring-loaded biopsy system (Medax Velox 2®) was used by experienced pneumologists. The obtained specimens were histologically evaluated and defined as adequate or non-adequate for diagnosis according to whether the material was considered appropriate or not for immunohistochemistry (IHC) analysis. The primary objective of the study was the diagnostic yield for a tissue diagnosis. Results: US-PPNB was diagnostic of MPM in 15 out of 18 patients (sensitivity: 83.39%; specificity: 100%; PPV: 100%). Three patients with non-adequate US-PPNB underwent thoracoscopy for diagnosis. We found significant differences in terms of mean pleural lesion thickness between patients with adequate and not-adequate biopsy (15.4 mm (SD: 9.19 mm) and 3.77 mm (SD: 0.60 mm), p < 0.0010. In addition, a significant positive correlation has been observed between diagnostic accuracy and FDG-PET avidity value. Conclusions: US-PPNB performed by a pneumologist represents a valid procedure with a high diagnostic yield and accuracy for the diagnosis of MPM, and may be considered as an alternative option in patients who are not suitable for thoracoscopy.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Ultrasound Guided Percutaneous Pleural Needle Biopsy for Malignant Pleural Mesothelioma

Iadevaia,

D’Agnano,

Pagliaro

et al. 2024

JCM

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“…Medical thoracoscopy is indicated for the evaluation of pleural effusions of unknown etiology and of pleural thickening, performing histological diagnosis and staging of pleural malignancies. 37 , 38 When the pleural thickening is circumferential and makes pleural cavity impassable, medical thoracoscopy is not possible. For this reason, we perform a mini thoracotomy and extrapleural biopsies.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of malignant pleural disease: Ultrasound as “a detective probe”

et al. 2022

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Background Malignant pleural mesothelioma (MPM) is an invasive, aggressive pleural tumor with a predominantly local spread. The objective of this study was to assess thoracic ultrasound (TUS) as an imaging modality with high sensitivity for the identification of malignant pleural involvement and in order to guide pleural biopsies. Methods In this retrospective single‐center study between January 2018 and June 2022, 51 consecutive patients with impassable circumferential pleural thickening underwent TUS at the Thoracic Surgery Unit of the Vanvitelli University of Naples. Pleural biopsies were performed, and then large and multiple samples were sent to the pathological anatomy for histological examination. Results In all patients who underwent ultrasound examination, we chose the optimal point of entry to perform pleural biopsies and selected the areas of greater thickening without pleural effusion. No patient had any complications. No drainage tubes were placed after the pleural biopsies and no pneumothorax was present during the following days of hospitalization. The patients were discharged on the second postoperative day. Conclusion With TUS the precise pleural thickening localization, local infiltration, mass extent, its nature (solid, cystic or complex) and ultrasound features can be easily defined. Furthermore, ultrasound is more economical than computed tomography and avoids the risks associated with radiation. Thoracic ultrasound is an important component of the diagnostic procedure in detecting a safe entry site for biopsies of MPMs.

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Medical thoracoscopy without pleural fluid: How I do it

Cited by 2 publications

References 7 publications

Diagnostic Accuracy of Ultrasound Guided Percutaneous Pleural Needle Biopsy for Malignant Pleural Mesothelioma

Diagnostic Accuracy of Ultrasound Guided Percutaneous Pleural Needle Biopsy for Malignant Pleural Mesothelioma

Diagnosis of malignant pleural disease: Ultrasound as “a detective probe”

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