PURPOSE: Medical thoracoscopy is performed under local anesthesia. It is less invasive and less expensive than video-assisted thoracic surgery. We have performed medical thoracoscopy using the Olympus (Tokyo, Japan) LTF-240 semi-flexible scope for the diagnosis of pleural effusion. To evaluate the usefulness of the LTF-240 scope, our experience was analyzed retrospectively.
METHODS: Medical thoracoscopy was considered for patients with pleural effusion of unknown etiology. The LTF-240 scope was inserted into the pleural space under local anesthesia, then forceps biopsies of the parietal pleura were taken under direct vision.
RESULTS: From Nov 2001 to Apr 2006, 67 patients were investigated. The diagnoses from medical thoracoscopy were malignant mesothelioma in 16 patients, adenocarcinoma of the lung in 13, other malignancy in 9, tuberculosis in 9, and nonspecific pleurisy in 19. There were four false negative diagnoses in nonspecific pleurisy cases (final diagnoses: one mesothelioma and three tuberculosis), and no false positive diagnosis. Our sensitivity, specificity, and accuracy were 92%, 100%, and 94% for specific finding, and 97%, 100%, and 98% for malignancy, respectively. There were 11 complications (10 patients) including 7 subcutaneous emphysema, two reexpansion pulmonary edema, and two hypoxia. All patients were recovered easily. There was no procedure-related death.
CONCLUSION: Medical thoracoscopy using the LTF-240 scope is a useful diagnostic procedure with high diagnostic accuracy and low morbidity.
CLINICAL IMPLICATIONS: For the diagnosis of pleural effusion, we should perform this procedure instead of blind percutaneous pleural biopsy.
DISCLOSURE: Masashi Kobayashi, None.