Pleural staging using local anesthetic thoracoscopy in dry pleural dissemination and minimal pleural effusion

Abstract

Background Dry pleural dissemination (DPD) and minimal (<10 mm thick) pleural effusion (PE) may be discovered intraoperatively as unexpected metastases. A definitive diagnostic procedure such as pleural biopsy is rarely attempted in such patients preoperatively. We retrospectively investigated the use and safety of local anesthetic thoracoscopy (LAT) as a pleural staging tool in the diagnosis of DPD and minimal PE. Methods We reviewed 18 patients with non‐small cell lung cancer (radiological DPD and minimal PE in 13 and five patients, respectively) who underwent LAT using a flex‐rigid pleuroscope for pleural staging from April 2015 to September 2020. Results The median age of the patients was 72 years. Nine patients (50%) were men. The dominant histological type was adenocarcinoma (n = 16). Three patients each with radiological DPD and minimal PE had visible PE on the LAT. Pleural biopsy was performed in the 16 cases in which pleural abnormalities were identified. On pleural staging, five cases were diagnosed without pleural dissemination (M0), and 13 cases were diagnosed with pleural dissemination (M1a). Only one case in which the lesion could not be identified because of pleural adhesions was false‐negative. The success rates for pleural staging, sensitivity, specificity, positive predictive value, and negative predictive value were 94.4% (17/18), 92.8% (13/14), 100% (4/4), 100% (13/13), and 80.0% (4/5), respectively. There were no lung lacerations or other severe complications caused by the procedure or during blunt dissection. Conclusion LAT might be a useful tool for accurate pleural staging in cases with DPD and minimal PE suspected radiologically.

Suitability of respiratory endoscopy for sampling malignant thoracic tumors for comprehensive genomic profiling

“…Therefore, both pleural biopsy and pleural effusion collection should be considered whenever possible. Medical thoracoscopy can be performed even in patients with minimal pleural effusion by creating an artificial pneumothorax 40 …”

“…Medical thoracoscopy can be performed even in patients with minimal pleural effusion by creating an artificial pneumothorax. 40 …”

“…Medical thoracoscopy can be performed even in patients with minimal pleural effusion by creating an artificial pneumothorax. 40 In general, the pathological evaluation of the suitability for CGP based on the area of the section and the proportion of tumor cell content was adequate, with corresponding results in all but one case. In contrast, only eight of 83 patients (9.6%) received targeted therapies according to the results, a lower rate than previously reported, which ranged from 10.5% to 13.4%.…”