Medical thoracoscopy, a minimally invasive procedure that uses a small camera to perform biopsies and treatments in the chest, has improved over the last three decades allowing for more accurate diagnosis of certain chest diseases including malignant mesothelioma, according to a study titled “Medical thoracoscopy: Analysis on diagnostic yield through 30 years of experience.”
Medical thoracoscopy (pleuroscopy) was first introduced in 1910 for the treatment of tuberculosis but soon began to be used with other indications. It is used currently to diagnose malignant and benign pleural diseases and to treat emphysema or conditions that allow buildup of fluid.
For the study recently published in Annals of Thoracic Medicine, Italian researchers examined the diagnostic value of pleuroscopy by using 2,752 pleuroscopies from 1984 through 2013 that were performed at Spedali Civili Hospital in Brescia, Italy.
To assess the evolution of pleuroscopy over time, the patients were grouped in six series of 5 years.
Among the total pleuroscopies analyzed 2,474 were performed with diagnostic intentions. The overall diagnostic yield was 71%. The percentage increased over time from 57.1% to 79.2%. Diagnosis yield was better in the presence of monolateral pleural effusion (abnormal collection of fluid in the pleural space) compared to bilateral pleural effusion.
Among the diagnoses more than half were of cancer, including malignant pleural mesothelioma and lung cancer metastasis. Tuberculosis was also commonly diagnosed. The frequency of all cancers also increased over time and stabilized in the fourth period (from 1999 to 2003).
The findings suggest that pleuroscopy can be improved with practice because the percentage of diagnosis from pleuroscopy increased over time and allowed for a specific diagnosis in nearly 80 percent of patients. However, the researchers note that their years of expertise allowed for an accurate selection of patients which may have also increased the percentage of diagnosed patients.