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Rigid versus semi‐rigid thoracoscopy for the diagnosis of pleural disease: A randomized pilot study
Author(s) -
Rozman Ales,
Camlek Luka,
MarcMalovrh Mateja,
Triller Nadja,
Kern Izidor
Publication year - 2013
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.12066
Subject(s) - thoracoscopy , medicine , forceps , surgery , pleural effusion , radiology
Background and objective Thoracoscopy with a semi‐rigid instrument is a recent technique successfully used for diagnosing pleural diseases. However, there are concerns about the diagnostic adequacy of biopsy samples obtained by semi‐rigid procedures when compared with rigid thoracoscopy. The purpose of this study was to compare the size, quality and diagnostic adequacy of biopsy specimens obtained at semi‐rigid and rigid thoracoscopy in a prospective, randomized fashion. Methods Patients with pleural effusion of unknown origin and/or pleural irregularities suspicious for pleural malignancy were included after less invasive means of diagnosis had failed. All procedures were performed under local anaesthesia with intravenous sedation/analgesia with a single point of entry. Patients were randomly assigned to a rigid instrument procedure ( O lympus E ndo EYE WA50120A , forceps) or semi‐rigid instrument procedure ( O lympus LTF ‐160, FB ‐ 55CR ‐1 forceps). Results Eighty‐four patients were randomized. Five of them were excluded because of lack of pleural space. Thirty‐eight patients were assigned to a rigid and 41 to a semi‐rigid procedure, with mean follow up 24.1 (±8.1) months after the procedure. The average size of the sample obtained by rigid thoracoscopy was 24.7 mm 2 (±12.9), and 11.7 mm 2 (±7.6) by semi‐rigid thoracoscopy. There were no differences in the quality and interpretability of the specimens assessed by the pathologist. The diagnostic accuracy was 100% for the rigid procedure and 97.6% for the semi‐rigid procedure. Conclusions The samples obtained by semi‐rigid thoracoscopy were smaller, but of adequate quality. The diagnostic accuracy was comparable with that of rigid thoracoscopy in the evaluation of pleural disease.