New Challenges in Medical Thoracoscopy

Abstract

Thoracoscopy is currently the gold standard for the diagnosis and treatment of pleural diseases. Its diagnostic yield is 95% in patients with malignant pleural disease, with approximately 90% successful pleurodesis for malignant pleural effusion and 95% for pneumothorax. At the same time, thoracoscopy constitutes an important tool in the research of pleural pathophysiology and molecular biology. The improvement of technology has provided important tools to thoracoscopy, such as autofluorescence, narrow band imaging, and infrared light, used in clinical and basic research in many disorders involving the pleura. For these reasons, training in thoracoscopy should be considered equally important as training in bronchoscopy for residents in respiratory medicine.

Medical thoracoscopy: Survey of current practice—How successful are medical thoracoscopists at predicting malignancy?

“…6 MT allows direct visualization of the pleura and subsequent biopsy of visually abnormal areas, providing a high diagnostic yield. [7][8][9][10] MT provides the option to pleurodese (to reduce risk of fluid recurrence) at the time of biopsy via talc poudrage, which has a success rate of 60-80%. 11 Pleural biopsy results are not available during the MT procedure, and therefore, in order to perform talc poudrage, the physician needs high clinical confidence of a malignant diagnosis macroscopically.…”

Management of Pleural Effusion by Combining Talc Poudrage and Indwelling Pleural Catheter: A Retrospective Single Center Study

“…The use of VATS allows a direct inspection of the pleura, the removing of adhesions and loculations of pleural fluid and to distribute talc evenly over the pleural surface [5]. VATS can also be used to obtain pleural biopsies with a diagnostic yield of 91-95% [11]. This makes it more versatile compared to the usage of simple talc slurries.…”

Application of Quantitative Autofluorescence Bronchoscopy Image Analysis Method in Identifying Bronchopulmonary Cancer

“…It can significantly improve early diagnosis sensitivity (Se) of lung cancer and precancerous lesions. 6 However, AFB also has some limitations, such as low specificity (Sp), because red fluorescence also shows, in cases of bronchial mucosal inflammation, inflammatory granuloma, scar tissue, and mucosal injury, which can easily be confused with precancerous lesions, carcinoma in situ (CIS), and invasive carcinoma. 7 Therefore, by means of quantification of fluorescence intensity at different histopathologic stages in the development of lung cancer, the method could play an important role in early diagnosis of lung cancer and assessment of the extent of local cancer.…”