PURPOSE: Narrow band imaging (NBI) is a new optical image enhancement technology used to highlight blood vessels on the mucosal surface and fine mucosal patterns. To evaluate the efficacy of NBI to detect malignant diseases in pleural space, we designed a prospective study.
METHODS: All patients scheduled for medical thoracoscopy to diagnose pleural effusions of unknown cause were enrolled in this study. All procedures were performed using flexi-rigid thoracoscope under local anesthesia with one port of entry. The pleural cavity was carefully inspected with both conventional white light and NBI, which could be changed easily using a button on the thoracoscope. Biopsy samples were obtained from the parietal pleura or diaphragm, where both images were recorded for subsequent evaluation of the procedure.
RESULTS: From May 2006 to April 2007, 26 patients (19 men and 7 women) were enrolled. Four patients were excluded from analyses because careful observation was impossible due to multiple adhesions, or because assessment with NBI was difficult due to hemorrhagic fibrin. Diagnoses were established in 21 of 22 cases, with malignant mesothelioma in 3 cases, other malignancies in 9 cases, and benign disease including infection in 9 cases. For the 22 analyzable patients, 29 biopsy specimens were obtained; 13 malignancies (4 malignant mesothelioma and 9 other malignancies) and 16 non-malignancies. Nine of the 29 biopsy sites showed abnormal blood vessel pattern, such as dilatation, tortuosity, and caliber change of the vessel. All 9 lesions were proved to be malignant by pathological assessment (4 malignant mesothelioma and 5 other malignancies). The mean examination time was 24.0 minutes. There were no major complications.
CONCLUSION: When compared with normal white light, NBI showed blood vessel patterns more clearly.
CLINICAL IMPLICATIONS: NBI has the possibility to detect pleural malignancies in early stage.
DISCLOSURE: Atsuko Ishida, No Financial Disclosure Information; No Product/Research Disclosure Information