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Kamatani M, Awano N, Inomata M, Kuse N, Sakamoto K, Kumasaka T, Izumo T. Diagnostic yields and safety of thoracoscopic cryobiopsies in Japan: A single-center retrospective observational study. Respir Investig 2024; 62:617-622. [PMID: 38718435 DOI: 10.1016/j.resinv.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/24/2024] [Accepted: 05/02/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Thoracoscopy is useful for diagnosing unexplained pleural effusions. A sufficient specimen volume is often difficult to obtain using forceps biopsies (FBs) but can be obtained with pleural cryobiopsies (CBs). This study aimed to assess the utility and safety of CB during thoracoscopy in the Japanese population. METHODS Patients who underwent thoracoscopic CBs at the Japanese Red Cross Medical Center between January 2017 and August 2023 were included in the study. Data were retrospectively analyzed, including clinical data, thoracoscopic findings, specimen size, diagnostic yield, and complications. The number of collected specimens and the freezing time were left to the discretion of the attending physician. RESULTS Twenty-six patients underwent thoracoscopic CB. Specimens obtained by CB were larger than those obtained by FB. Primary lung cancer was the most common cause of pleural effusion, followed by malignant pleural mesothelioma. CB contributed to the diagnosis in 24 of 26 cases (92.3%) and FB contributed to the diagnosis in 11 of 18 cases (61.1%). Severe fibrosis could be diagnosed in all 3 cases by CB, but not by FB. The common complications of CB included bleeding at the biopsy site and atelectasis, but no severe complications occurred. CONCLUSIONS The utility and safety of thoracoscopic CB for diagnosing pleural effusions in Japan were verified. The diagnostic yield, specimen size, and safety profile of CB support the diagnostic utility of this method.
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Affiliation(s)
- Miwa Kamatani
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, 150-8935, Japan
| | - Nobuyasu Awano
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, 150-8935, Japan.
| | - Minoru Inomata
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, 150-8935, Japan
| | - Naoyuki Kuse
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, 150-8935, Japan
| | - Keita Sakamoto
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, 150-8935, Japan
| | - Toshio Kumasaka
- Department of Pathology, Japanese Red Cross Medical Center, Tokyo, 150-8935, Japan
| | - Takehiro Izumo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, 150-8935, Japan
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Panou V, Bhatnagar R, Rahman N, Christensen TD, Pietersen PI, Arshad A, Laursen CB. Advances in the diagnosis and follow-up of pleural lesions: a scoping review. Expert Rev Respir Med 2024; 18:423-434. [PMID: 38995221 DOI: 10.1080/17476348.2024.2375421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION Pleural lesions may have heterogeneous presentation and causes. In recent years, there have been significant advances in pleural lesions diagnostics. The aim of this review is to provide an overview of the state-of-the-art, and recent updates for diagnostic modalities and monitoring regimes for pleural lesions. AREAS COVERED A literature search was conducted through PubMed and Web of Science for relevant articles published from 1 January 2000- 1 March 2023. This article critically appraises the radiological modalities and biopsy techniques that are employed in pleural lesions diagnostics, including chest radiography, thoracic ultrasound, computed tomography, F-fluorodeoxyglycose positron emission tomography, magnetic resonance imaging, percutaneous, and thoracoscopic pleural biopsies with reference to their strengths, limitations, and clinical use. The review asserts also the available literature regarding monitoring algorithms. EXPERT OPINION Despite the recent advances in the field, there are several key areas for improvement, including the development and validation of minimal invasive methods and tools for risk stratification, the integration of multi-omics technologies, the implementation of standardized, evidence-based diagnostic and monitoring guidelines and increased focus on research and patient-centric approaches. The broad establishment of dedicated pleural clinics may significantly assist toward this direction.
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Affiliation(s)
- Vasiliki Panou
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN) - Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rahul Bhatnagar
- Odense Respiratory Research Unit (ODIN) - Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Respiratory Medicine Department, North Bristol National Health Service Trust, Southmead Hospital, Bristol, UK
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Najib Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford Pleural Unit, Churchill Hospital, Oxford, UK
| | - Thomas Decker Christensen
- Department of Cardiothoracic and Vascular Surgery & Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Pia Iben Pietersen
- Department of Radiology, Odense University Hospital, Odense, Denmark
- UNIFY - Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Arman Arshad
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN) - Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Chawla RK, Kumar M, Madan A, Dhar R, Gupta R, Gothi D, Desai U, Goel M, Swarankar R, Nene A, Munje R, Chaudhary D, Guleria R, Hadda V, Nangia V, Sindhwani G, Chawla R, Dutt N, Yuvarajan, Dalal S, Gaur SN, Katiyar S, Samaria JK, Gupta KB, Koul PA, Suryakant, Christopher D, Roy D, Hazarika B, Luhadia SK, Jaiswal A, Madan K, Gupta PP, Prashad B, Yusuf N, James P, Dhamija A, Tomar V, Parakh U, Khan A, Garg R, Singh S, Joshi V, Sarangdhar N, Chaudhary SR, Nayar S, Patel A, Gupta M, Dixit RK, Jain S, Gogia P, Agarwal M, Katiyar S, Chawla A, Gonuguntala HK, Dosi R, Chinnamchetty V, Jindal A, Sharma S, Chachra V, Samaria U, Nair A, Mohan S, Maitra G, Sinha A, Kochar R, Yadav A, Choudhary G, Arunachalam M, Rangarajan A, Sanjan G. NCCP-ICS joint consensus-based clinical practice guidelines on medical thoracoscopy. Lung India 2024; 41:151-167. [PMID: 38700413 PMCID: PMC10959315 DOI: 10.4103/lungindia.lungindia_5_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 05/05/2024] Open
Abstract
ABSTRACT Medical Thoracoscopy (MT) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. The aim of the study was to provide evidence-based information regarding all aspects of MT, both as a diagnostic tool and therapeutic aid for pulmonologists across India. The consensus-based guidelines were formulated based on a multistep process using a set of 31 questions. A systematic search of published randomized controlled clinical trials, open labelled studies, case reports and guidelines from electronic databases, like PubMed, EmBase and Cochrane, was performed. The modified grade system was used (1, 2, 3 or usual practice point) to classify the quality of available evidence. Then, a multitude of factors were taken into account, such as volume of evidence, applicability and practicality for implementation to the target population and then strength of recommendation was finalized. MT helps to improve diagnosis and patient management, with reduced risk of post procedure complications. Trainees should perform at least 20 medical thoracoscopy procedures. The diagnostic yield of both rigid and semirigid techniques is comparable. Sterile-graded talc is the ideal agent for chemical pleurodesis. The consensus statement will help pulmonologists to adopt best evidence-based practices during MT for diagnostic and therapeutic purposes.
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Affiliation(s)
- Rakesh K. Chawla
- Department of Respiratory Medicine, Critical Care and Sleep Disorders, Jaipur Golden Hospital and Saroj Super Speciality Hospital, New Delhi, India
| | - Mahendra Kumar
- Department of Respiratory Medicine, Institute of Respiratory Diseases, SMS Medical College Jaipur, Rajasthan, India
| | - Arun Madan
- Department of Respiratory Medicine, NDMC Medical College, Delhi, India
| | - Raja Dhar
- Department of Pulmonology, C K Birla Group of Hospitals, Kolkata, West Bengal, India
| | - Richa Gupta
- Department of Respiratory Medicine, CMC Hospital, Vellore, Tamil Nadu, India
| | - Dipti Gothi
- Department of Respiratory Medicine, ESI- PGIMSR, Delhi, India
| | - Unnati Desai
- Department of Pulmonary Medicine, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Manoj Goel
- Department of Pulmonary, Critical Care and Sleep Medicine, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Rajesh Swarankar
- Respiratory, Critical Care and Sleep Medicine, Get Well Hospital and Research Institute, Nagpur, Maharashtra, India
| | - Amita Nene
- Department of Respiratory Medicine, Bombay Hospital, Mumbai, Maharashtra, India
| | - Radha Munje
- Department of Respiratory Medicine, IGGMCH Nagpur, Maharashtra, India
| | - Dhruv Chaudhary
- Department of Pulmonary Medicine, PGIMS Rohtak, Haryana, India
| | - Randeep Guleria
- Chairman, Institute of Internal Medicine, Respiratory and Sleep Medicine Medanta, Gurugram, Haryana, India
- Director, Medical Education Respiratory and Sleep Medicine Medanta, Gurugram, Haryana, India
| | - Vijay Hadda
- Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Nangia
- Pulmonary, Critical Care, and Sleep Medicine, MAX Super Speciality Hospital Saket, New Delhi, India
| | | | - Rajesh Chawla
- Respiratory Medicine, Indraprastha Apollo Hospitals, Delhi, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, AIIMS Jodhpur, Rajasthan, India
| | - Yuvarajan
- Department of Respiratory Medicine, SMVMCH, Pondicherry, India
| | - Sonia Dalal
- Pulmonologist and Director, Dalal Sleep and Chest Medical Institute Pvt Ltd Vadodara, Gujarat, India
| | - Shailendra Nath Gaur
- Department of Respiratory Medicine, Sharda Medical College, Noida, Uttar Pradesh, India
| | - Subodh Katiyar
- Department of Tuberculosis and Respiratory Diseases, G. S. V. M. Medical College, Kanpur, Uttar Pradseh, India
| | - Jai Kumar Samaria
- Department of Chest Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
- Director and Chief Consultant, Centre for Research and Treatment of Allergy, Asthma and Bronchitis and Dr. Samaria Multispeciality Centre Varanasi, Uttar Pradesh, India
| | - K. B Gupta
- Department of Pulmonary Medicine PGIMS Rohtak, Haryana, India
| | - Parvaiz A Koul
- Pulmonary Medicine and Director, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Suryakant
- Department of Respiratory Medicine, King George’s Medical University UP Lucknow, Uttar Pradesh, India
| | - D.J. Christopher
- Department of Pulmonary Medicine, CMC, Vellore, Tamil Nadu, India
| | - Dhrubajyoti Roy
- Pulmonary and Respiratory Medicine in Columbia Asia Hospital, Salt Lake Kolkata, West Bengal, India
| | - Basant Hazarika
- Department of Pulmonary Medicine Guwahati Medical College, Guwahati, Assam, India
| | - Shanti Kumar Luhadia
- Department of Respiratory Medicine, Geetanjali Medical College and Hospital Udaipur, Rajasthan, India
| | - Anand Jaiswal
- Director, Respiratory and Sleep Medicine Medanta, The Medicity Gurugram, Haryana, India
| | - Karan Madan
- Pulmonary Medicine and Sleep Disorders Department, AIIMS, Delhi, India
| | | | - B.N.B.M. Prashad
- Department of Respiratory Medicine, KGMC, Lucknow, Uttar Pradesh, India
| | - Nasser Yusuf
- Department of Minimally Invasive Thoracic Surgery, Sunrise Group of Hospitals Kochi, Calicut, Kerala, India
| | - Prince James
- Interventional Pulmonology and Respiratory Medicine Naruvi Hospitals, Vellore, Tamil Nadu, India
| | - Amit Dhamija
- Chest Medicine, Sir Ganga Ram Hospital New Delhi, India
| | - Veerotam Tomar
- Director and Consultant Pulmonologist, Dr Shivraj Memorial Chest and Maternity Centre Meerut, Uttar Pradesh, India
| | - Ujjwal Parakh
- Department of Respiratory Medicine, Sir Ganga Ram Hospital New Delhi, India
| | - Ajmal Khan
- Department of Pulmonary and Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow, Uttar Pradesh, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine AIIMS, New Delhi, India
| | - Sheetu Singh
- Director, Asthma Bhawan, Rajasthan Hospital, Rajasthan, India
| | - Vinod Joshi
- Principal and Controller, RUHS College of Medical Sciences, Jaipur, Rajasthan, India
| | - Nikhil Sarangdhar
- Department of Pulmonary Medicine, D. Y. Patil University School of Medicine, Navi Mumbai, Maharashtra, India
| | | | - Sandeep Nayar
- Senior Director and Head Centre for Chest and Respiratory Diseases BLK-Max Super Speciality Hospital, New Delhi, India
| | - Anand Patel
- Department of Pulmonary Medicine GMERS Medical College and Hospital, Gujarat, India
| | - Mansi Gupta
- Department of Pulmonary, Critical Care and Sleep Medicine, SGPGI Lucknow, Uttar Pradesh, India
| | - Rama Kant Dixit
- Department of Respiratory Medicine, J L N Medical College, Ajmer, Rajasthan, India
| | - Sushil Jain
- Department of Respiratory Medicine, APOLLO, Raipur, Chhattisgarh, India
| | - Pratibha Gogia
- Respiratory Medicine, Allergy and Sleep Disorders Department, Venkateshwar Hospital, Dwarka, New Delhi, India
| | - Manish Agarwal
- Pulmonary Medicine and Sleep Disorders Department, Jaipur Golden Hospital, Delhi, India
| | | | - Aditya Chawla
- Department of Respiratory Medicine, Sleep and Critical Care, Saroj Super Speciality Hospital and Jaipur Golden Hospital, New Delhi, India
| | | | - Ravi Dosi
- Consultant Chest Physician, Kokilaben Dhirubhai Ambani Hospital, Indore, Madhya Pradesh, India
| | - Vijya Chinnamchetty
- Lead Interventional Pulmonologist Apollo Health City, Hyderabad, Telangana, India
| | - Apar Jindal
- Lung Transplant Interventional Pulmonology and Respiratory Medicine MGM Healthcare, Chennai, Tamil Nadu, India
| | - Shubham Sharma
- Consultant Advanced Lung Failure and Transplant Pulmonologist, Yashoda Hospitals, Ghaziabad, UP, India
| | | | - Utsav Samaria
- Pulmonologist, Apollo Spectra Kanpur, Uttar Pradesh, India
| | - Avinash Nair
- Department of Respiratory Medicine Christian Medical College, Vellore, Tamil Nadu, India
| | - Shruti Mohan
- Department of Respiratory Medicine, Jaipur Golden Hospital New Delhi, India
| | - Gargi Maitra
- Pulmonologist, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Ashish Sinha
- Department of Respiratory Medicine, Jaipur Golden Hospital New Delhi, India
| | - Rishabh Kochar
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS Jodhpur, Rajasthan, India
| | - Ajit Yadav
- Department Respiratory Medicine MMIMSR, Ambala, Haryana, India
| | - Gaurav Choudhary
- Department of Respiratory Medicine, Jaipur Golden Hospital New Delhi, India
| | - M Arunachalam
- Pulmonary and Sleep Medicine Yatharth Wellness Super Speciality Hospital, Noida, Uttar Pradesh, India
| | | | - Ganesh Sanjan
- SR Pulmonary Medicine AIIMS, Rishikesh, Uttarakhand, India
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Gonnelli F, Hassan W, Bonifazi M, Pinelli V, Bedawi EO, Porcel JM, Rahman NM, Mei F. Malignant pleural effusion: current understanding and therapeutic approach. Respir Res 2024; 25:47. [PMID: 38243259 PMCID: PMC10797757 DOI: 10.1186/s12931-024-02684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024] Open
Abstract
Malignant pleural effusion (MPE) is a common complication of thoracic and extrathoracic malignancies and is associated with high mortality and elevated costs to healthcare systems. Over the last decades the understanding of pathophysiology mechanisms, diagnostic techniques and optimal treatment intervention in MPE have been greatly advanced by recent high-quality research, leading to an ever less invasive diagnostic approach and more personalized management. Despite a number of management options, including talc pleurodesis, indwelling pleural catheters and combinations of the two, treatment for MPE remains symptom directed and centered around drainage strategy. In the next future, because of a better understanding of underlying tumor biology together with more sensitive molecular diagnostic techniques, it is likely that combined diagnostic and therapeutic procedures allowing near total outpatient management of MPE will become popular. This article provides a review of the current advances, new discoveries and future directions in the pathophysiology, diagnosis and management of MPE.
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Affiliation(s)
- Francesca Gonnelli
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona Via Conca 71, Ancona, 60126, Italy
| | - Wafa Hassan
- Department of Respiratory Medicine, Sheffield Teaching Hospitals, University of Sheffield, Sheffield, UK
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona Via Conca 71, Ancona, 60126, Italy
| | | | - Eihab O Bedawi
- Department of Respiratory Medicine, Sheffield Teaching Hospitals, University of Sheffield, Sheffield, UK
| | - José M Porcel
- Research Group of Cancer Biomarkers, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
- Pleural Medicine and Clinical Ultrasound Unit, Department of Internal Medicine, Arnau de Vilanova, University Hospital, Lleida, Spain
| | - Najib M Rahman
- Oxford Pleural Unit, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Unit, Oxford, UK
- Chinese Academy of Medicine Oxford Institute, Oxford, UK
| | - Federico Mei
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona Via Conca 71, Ancona, 60126, Italy.
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Ali MS, Ghori UK, Wayne MT, Shostak E, De Cardenas J. Diagnostic Performance and Safety Profile of Robotic-assisted Bronchoscopy: A Systematic Review and Meta-Analysis. Ann Am Thorac Soc 2023; 20:1801-1812. [PMID: 37769170 DOI: 10.1513/annalsats.202301-075oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 09/27/2023] [Indexed: 09/30/2023] Open
Abstract
Rationale: Conventional electromagnetic navigation bronchoscopy and other guided bronchoscopic modalities have a very desirable safety profile, but their diagnostic yield is only 60-70% for pulmonary lesions. Recently, robotic-assisted bronchoscopy (RAB) platforms have been introduced to improve the diagnostic performance of bronchoscopic modalities. Objectives: To determine the diagnostic performance and safety profile of RAB (using shape-sensing and electromagnetic navigation-based platforms) by performing a systematic review and meta-analysis. Methods: The PubMed, Embase, and Google Scholar databases were searched to find studies that reported on the diagnostic performance and/or the safety profile of one of the RAB systems. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-analysis was performed using MedCalc version 20.118. Pooled diagnostic yield was calculated using a Freeman-Tukey transformation. We planned to use a random-effects model if the I2 index was >40%. Results: Twenty-five studies were included: 20 including diagnostic and safety analyses and 5 including only safety analyses. The pooled diagnostic yield of RAB (20 studies, 1,779 lesions) was 84.3% (95% confidence interval, 81.1-87.2%). The I2 index was 65.6%. On the basis of our subgroup analyses, the heterogeneity was likely driven by differences in study designs (prospective vs. retrospective) and procedural protocols (such as different RAB systems). Lesion size > 2 cm, the presence of a computed tomography bronchus sign, and concentric radial endobronchial ultrasound view were associated with a statistically significant increase in the odds of diagnosis with RAB. The overall rates of pneumothorax, need for tube thoracostomy, and significant hemorrhage were 2.3%, 1.2%, and 0.5%, respectively. Conclusions: RAB systems have significantly increased the diagnostic yield of navigational bronchoscopy compared with conventional systems such as electromagnetic navigation bronchoscopy, but well-designed prospective studies are needed to better understand the impact of various factors, such as the use of three-dimensional imaging modalities, cryobiopsy, and specific ventilatory protocols, on the diagnostic yield of RAB.
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Affiliation(s)
- Muhammad Sajawal Ali
- Division of Pulmonary and Critical Care Medicine
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Uzair Khan Ghori
- Division of Pulmonary, Critical Care and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Max Theodore Wayne
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Eugene Shostak
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Jose De Cardenas
- Division of Pulmonary, Critical Care and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; and
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Eldredge RS, McMahon L. Intercostal nerve cryoablation therapy for the repair of pectus excavatum: a systematic review. Front Surg 2023; 10:1235120. [PMID: 37693640 PMCID: PMC10484532 DOI: 10.3389/fsurg.2023.1235120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction The minimally invasive repair of pectus excavatum (PE) is a painful procedure that can result in long-term hospitalization and opioid use. To mitigate the length of stay and opioid consumption, many different analgesia strategies have been implemented. The aim of this study is to review the use and patient outcomes of intercostal nerve cryoablation (INC) during PE repair reported in the literature. Methods An unfunded literature search using PubMed identifying articles discussing INC during PE repair from 1946 to 1 July 2023 was performed. Articles were included if they discussed patient outcomes with INC use during PE repair. Articles were excluded if they were reviews/meta-analyses, editorials, or not available in English. Each article was reviewed for bias by analyzing the study methods, data analysis, patient selection, and patient follow-up. Articles comparing outcomes of INC were considered significant if p-value was <0.05. Results A total of 34 articles were included in this review that described INC use during pectus repair. Most supported a decreased hospital length of stay and opioid use with INC. Overall, INC was associated with fewer short-term and long-term complications. However, the researchers reported varied results of total hospital costs with the use of INC. Conclusion The review was limited by a paucity of prospective studies and low number of patients who received INC. Despite this, the present data support INC as a safe and effective analgesic strategy during the repair of PE.
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Affiliation(s)
| | - Lisa McMahon
- Department of Surgery, Division of Pediatric Surgery, Phoenix Children’s Hospital, Phoenix, AZ, United States
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Sikachi RR, Chaddha U, Agrawal A. Anesthetic considerations for medical pleuroscopy. Respir Med 2023; 213:107225. [PMID: 37028564 DOI: 10.1016/j.rmed.2023.107225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/09/2023] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Abstract
Pleuroscopy, also known as medical thoracoscopy or local anesthesia thoracoscopy, is a commonly utilized procedure in the growing field of interventional pulmonology and considered a required procedure as part of the interventional pulmonology fellowship curriculum. Pleuroscopy is mainly utilized for parietal pleural biopsies in patients with undiagnosed pleural effusions, with a comparable diagnostic yield to video-assisted thoracoscopy (VATS) (>92%). Pleuroscopy is also performed for talc insufflation for pleurodesis, indwelling pleural catheter insertion, and rarely for decortication in patients with stage 2 empyema. Though these procedures can be done under local anesthesia with moderate sedation, an increasing number of cases are being performed with the presence of the anesthesiologist providing monitored anesthesia care (MAC). Given that a significant number of patients undergoing pleuroscopy will have significant co-morbidities, proceduralists and anesthesiologists must be prepared to manage these cases in a non-OR setup. In this article, we discuss some of the technical aspects of pleuroscopy, and highlight the peri-operative considerations for proceduralists and anesthesiologists in managing these patients including the role of ultrashort sedatives and intraoperative procedural and anesthetic considerations. We also discuss the upcoming adjunctive role of local and regional anesthesia techniques in management of these patients. In addition, we summarize the current data regarding various regional anesthesia techniques and discuss avenues for further research.
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Affiliation(s)
- Rutuja R Sikachi
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai West & Morningside, New York, NY, USA
| | - Udit Chaddha
- Division of Pulmonary, Critical Care & Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Abhinav Agrawal
- Interventional Pulmonology, Division of Pulmonary, Critical Care & Sleep Medicine & Department of Cardiovascular & Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA.
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Recuero Díaz JL, Figueroa Almánzar S, Gálvez Muñoz C, Lázaro Sierra J, López Porras M, Márquez Medina D, Nabal Vicuña M, Sánchez Moreno L, González Cantalejo M, Porcel JM. Recommendations of the Spanish Society of Thoracic Surgery for the management of malignant pleural effusion. Cir Esp 2022; 100:673-683. [PMID: 35667609 DOI: 10.1016/j.cireng.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
This article summarizes the clinical guidelines for the diagnosis and treatment of malignant pleural effusion (MPE) sponsored by the Spanish Society of Thoracic Surgery (SECT). Ten clinical controversies were elaborated under the methodology of PICO (Patient, Intervention, Comparison, Outcome) questions and the quality of the evidence and grading of the strength of the recommendations was based on the GRADE system. Immunocytochemical and molecular analyses of pleural fluid may avoid further invasive diagnostic procedures. Currently, the definitive control of MPE can be achieved either by pleurodesis (talc poudrage or slurry) or the insertion of a indwelling pleural catheter (IPC). It is likely that the combination of both techniques (i.e., thoracoscopy with talc poudrage and insertion of a IPC, or instillation of talc slurry through a IPC) will have a predominant role in the future therapeutic management.
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Affiliation(s)
- José Luis Recuero Díaz
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria (IIS) de Aragón, Zaragoza, Spain.
| | | | - Carlos Gálvez Muñoz
- Servicio de Cirugía Torácica, Hospital Universitario de Alicante, Alicante, Spain
| | - Javier Lázaro Sierra
- Instituto de Investigación Sanitaria (IIS) de Aragón, Zaragoza, Spain; Servicio de Neumología, Hospital Royo Villanova, Zaragoza, Spain
| | - Marta López Porras
- Servicio de Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Diego Márquez Medina
- Instituto de Investigación Sanitaria (IIS) de Aragón, Zaragoza, Spain; Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain
| | - María Nabal Vicuña
- Cuidados Paliativos, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Laura Sánchez Moreno
- Servicio de Cirugía Torácica, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Mar González Cantalejo
- Servicio de Información Biomédica y Biblioteca, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - José M Porcel
- Unidad de Medicina Pleural, Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, Spain; Institut de Recerca Biomèdica de Lleida Fundació Dr. Pifarré (IRBLleida), Lleida, Spain; Universitat de Lleida, Lleida. Spain
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9
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Morita C, Kitamura A, Kinoshita K, Sueyoshi K, Murakami M, Ro S, Imai R, Okafuji K, Kojima F, Tomishima Y, Jinta T, Bando T, Nishimura N. A case of a thoracic mass negative on thoracentesis diagnosed by cryobiopsy from the visceral pleura. Respirol Case Rep 2022; 10:e01050. [PMID: 36268501 PMCID: PMC9577260 DOI: 10.1002/rcr2.1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Thoracoscopy under local anaesthesia is recommended for malignant tumours with negative pleural effusion cytology. Cryobiopsy from the visceral pleura by thoracoscopy under local anaesthesia can provide more diagnostic options for patients with thoracentesis‐negative malignant effusions. Here we present the first case in which this technique was used. The patient had a pleural metastasis that could not be diagnosed even with rapid cytology of the parietal pleura biopsy. Indications, technical pitfalls, and safety tips are discussed.
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Affiliation(s)
- Chie Morita
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan,Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
| | - Atsushi Kitamura
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Katsuhito Kinoshita
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Kuniyo Sueyoshi
- Department of Thoracic Surgery, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Manabu Murakami
- Department of Anesthesia and Intensive Care UnitSt. Luke's International HospitalTokyoJapan
| | - Shosei Ro
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Ryosuke Imai
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Kohei Okafuji
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Fumitsugu Kojima
- Department of Thoracic Surgery, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Yutaka Tomishima
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Torahiko Jinta
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Toru Bando
- Department of Thoracic Surgery, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Naoki Nishimura
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
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10
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DeMaio A, Thiboutot J, Yarmus L. Applications of cryobiopsy in airway, pleural, and parenchymal disease. Expert Rev Respir Med 2022; 16:875-886. [PMID: 36069255 DOI: 10.1080/17476348.2022.2122444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION :Cryobiopsy is a novel diagnostic technique for thoracic diseases which has been extensively investigated over the past 20 years. It was originally proposed for the diagnosis of endobronchial lesions and diffuse parenchymal lung disease due to limitations of conventional sampling techniques including small size and presence of artifacts. AREAS COVERED :We will review recent evidence related to the expanding use of cryobiopsy in thoracic diseases. To identify references, the MEDLINE database was searched from database inception until May 2022 for case series, cohort studies, randomized controlled trials, systematic reviews and meta-analyses related to cryobiopsy. EXPERT OPINION Cryobiopsy has expanding applications in the field of thoracic diseases. Evidence to support transbronchial cryobiopsy as an alternative to surgical lung biopsy is increasing and was recently endorsed as a conditional recommendation by the latest American Thoracic Society guideline update for Idiopathic Pulmonary Fibrosis. Developments in technology and technique, in particular the availability of a 1.1 mm flexible cryoprobe, have extended applications to pulmonary diseases, including diagnosis of interstitial lung diseases, peripheral pulmonary lesions, and lung transplant rejection.
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Affiliation(s)
- Andrew DeMaio
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Jeffrey Thiboutot
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Lonny Yarmus
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine.,Division of Pulmonary and Critical Care Medicine
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11
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Recuero Díaz JL, Figueroa Almánzar S, Gálvez Muñoz C, Lázaro Sierra J, López Porras M, Márquez Medina D, Nabal Vicuña M, Sánchez Moreno L, González Cantalejo M, M. Porcel J. Recomendaciones de la Sociedad Española de Cirugía Torácica para el manejo del derrame pleural maligno. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Giri M, Dai H, Guo S, Li Y, He L, Zhuang R. Efficacy and Safety of Pleural Cryobiopsy vs. Forceps Biopsy for Evaluation of Undiagnosed Pleural Effusion: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:847146. [PMID: 35479946 PMCID: PMC9035697 DOI: 10.3389/fmed.2022.847146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 03/21/2022] [Indexed: 12/05/2022] Open
Abstract
Background Pleural cryobiopsy is a novel technique for the diagnosis of pleural pathologies. However, the safety and feasibility of this modality compared to standard forceps for pleural biopsy has not been fully elucidated. This systematic review and meta-analysis aims to establish the efficacy and safety of cryobiopsy for evaluation of undiagnosed pleural effusion. Methods For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and Web of science databases up to December 16, 2021 to identify relevant articles. We included randomized controlled trials, cohort studies, retrospectives studies and case series that compared pleural cryobiopsy and forceps biopsy. A qualitative assessment was performed using the QUADAS-2 tool. Results Of the 365 articles identified by our search, 15 studies were eligible for inclusion. The specimen sizes obtained with cryobiopsy were significantly larger compared with forceps biopsy (Standard mean difference 1.16; 95 % CI: 0.51–1.82; P < 0.01). Furthermore, the cryobiopsy tissue specimens were deeper (OR 2.68; 95 % CI: 1.39–5.16; P < 0.01) and qualitatively better with less crush artifacts (OR 0.06; 95 % CI: 0.01–0.26; P < 0.01). There was no significant difference in diagnostic yield (OR 1.32; 95 % CI: 0.79–2.21; P = 0.29) and mild to moderate bleeding events (OR 1.21; 95 % CI: 0.64–2.29; P = 0.57) between pleural cryobiopsy and forceps biopsy. No publication bias was observed among these studies. Conclusions Compared to flexible forceps biopsy pleural cryobiopsy obtained larger and deeper tissue specimens with less crush artifacts but does not show superiority for diagnostic yield. Further studies are still needed to verify these findings.
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Affiliation(s)
- Mohan Giri
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haiyun Dai
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuliang Guo
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Shuliang Guo
| | - Yishi Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin He
- Department of Respiratory and Critical Care Medicine, Fuling Central Hospital, Chongqing, China
| | - Rongjuan Zhuang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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13
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Flora AS. The role of interventional pulmonology in pleural disease diagnosis and management. Curr Opin Pulm Med 2022; 28:68-72. [PMID: 34698676 DOI: 10.1097/mcp.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Pleural disease guidelines have not been updated in a decade. Advances have been made in the diagnosis and management of pleural diseases since, with expanding evidence of the utility of medical thoracoscopy (MT) as a safe and effective tool. RECENT FINDINGS Although thoracic ultrasound has improved early determination of pleural disease etiology, thoracentesis remains limited, and pleural tissue is necessary for the diagnosis of undifferentiated exudative pleural effusions. Medical thoracoscopy has been shown to be superior to traditional closed pleural biopsy, and recent literature is focused on which technique is best. A recent randomized controlled trial (RCT) found rigid mini-thoracoscopy was not superior to semirigid thoracoscopy. Meta-analyses have not found pleural cyrobiopsy to be superior to forceps biopsies. As a therapeutic tool, meta-analysis suggests MT as a possible first-line tool for the treatment of complicated parapneumonic effusions (CPE) and early empyema. A RCT comparing MT to intrapleural fibrinolytic therapy demonstrated that the former technique is safe, effective, and may shorten hospital length of stay in patients with CPE/empyema. SUMMARY The implications of the recent findings in the medical literature are that medical thoracoscopy, particularly by trained Interventional Pulmonologists, will find an expanded role in future iteration of pleural disease guidelines.
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Affiliation(s)
- Arjan S Flora
- Interventional Pulmonology Service, Division of Pulmonary, Critical Care, and Sleep Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
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14
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Abstract
Medical thoracoscopy is an effective and safe modality to visualize and sample contents of the pleural cavity. It is an outpatient procedure that can be performed while the patient is spontaneously breathing, with the use of local anesthesia and intravenous medications for sedation and analgesia. Medical thoracoscopy has indications in the management of a variety of pleural diseases. It is most commonly performed as a diagnostic procedure but has therapeutic applications as well. Although it has its advantages, management strategies of certain pleural diseases should take place within a multidisciplinary environment including general pulmonologists, interventional pulmonologists, and thoracic surgeons.
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15
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Imabayashi T, Matsumoto Y, Tanaka M, Nakai T, Tsuchida T. Pleural staging using local anesthetic thoracoscopy in dry pleural dissemination and minimal pleural effusion. Thorac Cancer 2021; 12:1195-1202. [PMID: 33629523 PMCID: PMC8046058 DOI: 10.1111/1759-7714.13894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 12/25/2022] Open
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.
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Affiliation(s)
- Tatsuya Imabayashi
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Midori Tanaka
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Toshiyuki Nakai
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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16
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Madan K, Tiwari P, Thankgakunam B, Mittal S, Hadda V, Mohan A, Guleria R. A survey of medical thoracoscopy practices in India. Lung India 2021; 38:23-30. [PMID: 33402634 PMCID: PMC8066931 DOI: 10.4103/lungindia.lungindia_295_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Medical thoracoscopy (MT) is a useful diagnostic and therapeutic procedure for a variety of pleural conditions. There is a lack of literature on prevalent practices of MT in India. Aims and Objectives: The objective of the study was to study the prevalent practices of MT in India. Materials and Methods: A structured online survey on various aspects of thoracoscopy was designed on the “Google Forms” web software. Results: One hundred and eight responses were received, of which 100 respondents performed MT. The majority were pulmonologists, and most had started performing thoracoscopy within the last 5 years. Rigid thoracoscope was the most commonly used instrument. The common indications of procedure included undiagnosed pleural effusion, talc pleurodesis, and adhesiolysis. Local anesthesia with conscious sedation was the preferred anesthetic modality. Midazolam, along with fentanyl, was the most widely used sedation combination. 2% lignocaine was the most commonly used concentration for local infiltrative anesthesia. Nearly two-thirds of the respondents reported having encountered any complication of thoracoscopy. Significant reported complications included empyema, incision/port-site infection, re-expansion pulmonary edema, and procedure-related mortality. Conclusion: MT is a rapidly evolving interventional pulmonology procedure in India. There is, however, a significant variation in practice and variable adherence to available international guidelines on thoracoscopy. Formal training programs within India and national guidelines for pleuroscopy considering the local resources are required to improve the safety and yield of this useful modality.
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Affiliation(s)
- Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Balamugesh Thankgakunam
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi; Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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17
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Botana Rial M, Lojo Rodríguez I, Mouronte Roibás C, Leiro Fernández V, Núñez Delgado M, Salgado Barreira Á, Pereira Torrado A, Fernández Villar A. Rentabilidad diagnóstica y seguridad de la criobiopsia pleural durante la toracoscopia médica en el estudio del derrame pleural. Una revisión sistemática y metaanálisis. Arch Bronconeumol 2020. [DOI: 10.1016/j.arbres.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Ishii S, Watanabe H, Suzuki M, Hashimoto M, Iikura M, Izumi S, Hojo M, Sugiyama H. Evaluation of the efficacy and safety of a new flex-rigid pleuroscope. CLINICAL RESPIRATORY JOURNAL 2020; 15:91-96. [PMID: 32949105 PMCID: PMC7891332 DOI: 10.1111/crj.13274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/04/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022]
Abstract
Objective New flex‐rigid pleuroscope enables observations with a maximum angle of curvature of 180°, allowing visualization of the area near the insertion site of the pleuroscope. And, it improved the image quality and channel inner diameter. The aim of this study was to evaluate the clinical effectiveness and safety of a new flex‐rigid pleuroscope. Methods A retrospective analysis of patients who were examined with a new flex‐rigid pleuroscope under local anesthesia at our institution was conducted. Pleuroscopy was performed in 33 patients with undiagnosed exudative pleural effusions from December 2016 to March 2019. Results A total of 33 patients (10 women, 23 men); their median age 74 years (range 24‐90) were investigated. Pleuroscopy showed that 18 had malignant pleural disease (54%), and 15 had benign pleural diseases (46%). The top three most frequent causes of pleural disease were pleural metastases of lung carcinoma (30.3%), pyothorax (15.1%), and malignant pleural mesothelioma (12.1%). In 32 cases (97%), observation at the introducer insertion site was possible. It was not possible in one case due to hard adhesions. The diagnostic rate was 100%, and the complication rate was 6.1%. There were no major complications, and minor complications included mild pain (one case) and minor bleeding (one case) that was stanched spontaneously. Conclusions The new flex‐rigid pleuroscope is effective and safe for diagnosing pleural effusions. The improved bending angle is likely to minimize the blind area. The new pleuroscopy fiberscope may improve the diagnostic rate.
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Affiliation(s)
- Satoru Ishii
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan.,Course of Advanced and Specialized Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiromu Watanabe
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Manabu Suzuki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masao Hashimoto
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Motoyasu Iikura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinyu Izumi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masayuki Hojo
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Haruhito Sugiyama
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
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19
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Ishii S, Suzuki M, Arai H, Takasaki J, Hojo M, Sugiyama H. Use of pleural cryobiopsy for tissue culture specimens: a case report. Respirol Case Rep 2020; 8:e00593. [PMID: 32514353 PMCID: PMC7273824 DOI: 10.1002/rcr2.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 11/10/2022] Open
Abstract
A 43-year-old man presented with cough. His chest X-ray showed a left-sided pleural effusion. We suspected tuberculous pleurisy (TP), and thoracoscopy under local anaesthesia was performed. It showed entire pleura with scattered nodules. Nodules were biopsied by conventional biopsy forceps, but the tissue sample was small. Therefore, the nodules were biopsied with a cryoprobe. The tissue size obtained was 2 mm by conventional biopsy forceps, and 6 mm at 5 sec by cryobiopsy. Histological analysis of the conventional biopsy forceps and cryobiopsy specimen showed inflammation with lymphocytes and caseating granulomas. Tissue culture of conventional biopsy forceps was positive for Mycobacterium tuberculosis, and all sensitivity tests were positive. But, the tissue culture of the cryobiopsy sample was negative. There is a possibility that cryobiopsy is not useful for tissue culture for TP.
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Affiliation(s)
- Satoru Ishii
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
| | - Manabu Suzuki
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
| | - Hirokazu Arai
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
| | - Jin Takasaki
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
| | - Masayuki Hojo
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
| | - Haruhito Sugiyama
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
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20
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Ishii S, Watanabe H, Izumi S, Hojo M, Sugiyama H. Pleural cryobiopsy is useful for comprehensive cancer genetic panel testing. Respirol Case Rep 2020; 8:e00581. [PMID: 32419948 PMCID: PMC7221240 DOI: 10.1002/rcr2.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/03/2020] [Accepted: 04/23/2020] [Indexed: 11/12/2022] Open
Abstract
An 83-year-old woman presented with dyspnoea. Her chest X-ray showed a right-sided pleural effusion. Flex-rigid pleuroscopy was performed and showed a mass in the anterior portion. The mass was biopsied with conventional biopsy forceps, but the mass was solid, and sufficient tissues could not be obtained. Therefore, the mass was biopsied with a cryoprobe. The tip of the probe was attached to the mass, and it was cooled with carbon dioxide once for 5 sec and then for 7 sec in the same place. The tissue size obtained was 2 mm by conventional biopsy forceps, and 5 mm at 5 sec and 12 mm at 7 sec by cryobiopsy. Histological analysis of the conventional biopsy forceps specimen showed cancer cells in the glandular cavity, but it was not sufficient tissue for comprehensive cancer genetic panel (CGP) testing. The cryobiopsy specimens showed cancer cells and sufficient tissue for comprehensive CGP testing.
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Affiliation(s)
- Satoru Ishii
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
| | - Hiromu Watanabe
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
| | - Shinyu Izumi
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
| | - Masayuki Hojo
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
| | - Haruhito Sugiyama
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
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21
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Agrawal A, Murgu S. Multimodal approach to the management of malignant pleural effusions: role of thoracoscopy with pleurodesis and tunneled indwelling pleural catheters. J Thorac Dis 2020; 12:2803-2811. [PMID: 32642188 PMCID: PMC7330308 DOI: 10.21037/jtd.2020.03.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Malignant pleural effusion (MPE) is associated with a median survival of 3–6 months and causes significant symptoms affecting the overall quality of life in patients with advanced malignancies. Despite the high incidence of recurrent MPE, less than 25% of patients undergo a definitive pleural intervention as recommended by guidelines. In this review, we summarize the latest guidelines for management of MPE by various societies and discuss a multimodal approach in these patients using thoracoscopy with pleurodesis using talc insufflation and placement of tunneled indwelling pleural catheters (TIPC). We also address the role of diagnostic thoracoscopy for histologic and molecular diagnosis and outline our approach to patients with known or suspected MPE.
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Affiliation(s)
- Abhinav Agrawal
- Interventional Pulmonology, Section of Pulmonary & Critical Care, The University of Chicago Medicine, Chicago, IL, USA
| | - Septimiu Murgu
- Interventional Pulmonology, Section of Pulmonary & Critical Care, The University of Chicago Medicine, Chicago, IL, USA
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