内科的胸腔鏡の進歩と胸膜生検法の工夫

Abstract

━━ Conventionally, when diagnosing cases of malignant pleural effusion, examinations have been performed by thoracentesis and a blind pleural biopsy, but the diagnosis rate has never been satisfactory. In particular, malignant pleural mesothelioma has a low positive rate using the above-mentioned method, which may lead to a misdiagnosis, so careful judgment is required. In Japan, medical thoracoscopy has been introduced since 1990, and it has become possible to directly observe and biopsy pleural lesions, which has dramatically improved the diagnosis rate. In lung cancer treatment, this approach is useful not only for making a pathological diagnosis but also for performing biomarker tests. However, pleural lesions often become thickened, fibrous and hard, regardless of the cause, so improvement of the biopsy technique is required. This review outlines the advances in medical thoracoscopy and ingenuity concerning pleural biopsy techniques.