Pleural staging using local anesthetic thoracoscopy in dry pleural dissemination and minimal pleural effusion.
Dry pleural dissemination
interventional pulmonology
local anesthetic thoracoscopy
minimal pleural effusion
non-small cell lung cancer
Journal
Thoracic cancer
ISSN: 1759-7714
Titre abrégé: Thorac Cancer
Pays: Singapore
ID NLM: 101531441
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
revised:
01
02
2021
received:
03
12
2020
accepted:
01
02
2021
pubmed:
26
2
2021
medline:
20
11
2021
entrez:
25
2
2021
Statut:
ppublish
Résumé
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. 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. 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. LAT might be a useful tool for accurate pleural staging in cases with DPD and minimal PE suspected radiologically.
Sections du résumé
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.
Identifiants
pubmed: 33629523
doi: 10.1111/1759-7714.13894
pmc: PMC8046058
doi:
Substances chimiques
Anesthetics, Local
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1195-1202Subventions
Organisme : National Cancer Center Research and Development Fund
ID : 29-A-13
Informations de copyright
© 2021 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.
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