Chest
Volume 114, Issue 1, July 1998, Pages 150-153
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Clinical Investigations
Investigation of Pleural Effusion: An Evaluation of the New Olympus LTF Semiflexible Thoracofiberscope and Comparison With Abram's Needle Biopsy

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Study objectives

Recently, pulmonologists have performed thoracoscopy under local anesthesia using rigid thoracoscopes or flexible bronchoscopes. The latter allow greater access within the pleural cavity but are difficult to manipulate. The Olympus LTF semiflexible fiberoptic thoracoscope combines features of both instruments, having a solid body and a flexible terminal section. In the first study with this instrument, we evaluated ease of use and compared diagnostic yield with closed needle biopsy.

Patients

Twenty-four patients with pleural effusion were investigated.

Setting

Scottish University Hospital.

Design

Thoracoscopy was performed in the bronchoscopy suite after premedication with atropine and papaveretum. Following a standard Abram's needle biopsy, the LTF thoracoscope was inserted through a flexible introducer (Olympus Optical Co Ltd; Tokyo, Japan). The pleura was inspected and biopsy specimens were taken of suspicious areas.

Results

The final diagnosis was malignant pleural effusion in 16 of 24 patients. Ten of 16 were positive by Abram's biopsy, giving a sensitivity of 62%. Thirteen of 16 were positive by fiberoptic thoracoscopy, giving an improved sensitivity of 81%. The LTF thoracoscope was easy to use for pulmonologists experienced in rigid thoracoscopy and flexible bronchoscopy. Excellent views of the pleura were obtained from a single entry point. The procedure was well tolerated and no complications were encountered.

Conclusion

The LTF thoracoscope allows excellent pleural access but a larger biopsy channel (currently 2 mm) might increase the accuracy of diagnosis.

Section snippets

Study Setting and Patient Selection

Patients were recruited from the Respiratory Clinic at Gartnavel General Hospital in the west of Glasgow. The clinic serves a population of 250,000, many of whom have had shipyard asbestos exposure.

Twenty-four patients (5 female), aged 25 to 85 years, were investigated. All patients had pleural effusion of unknown cause. The most common reason for referral was suspicion of malignancy. Results of fluid cytologic studies had been negative in all cases. Patients were included if they were fit

The Thoracofiberscope in Use

The plastic trocar and tube were easy to insert. The flexibility of the trocar tube in the chest wall allowed more freedom to move the thoracofiberscope than found with metal trocar tubes. The viewing quality was comparable to that from a conventional fiberoptic bronchoscope and allowed abnormal areas to be identified. However, lighting was not as good as that obtainable from rigid thoracoscopes. The main body handled like a rigid thoracoscope while the flexible tip allowed the entire pleural

Discussion

Thoracoscopy is not used routinely by pulmonologists in either the United States or the United Kingdom, but it is used more widely in continental Europe.2 Most US and UK pulmonologists, however, are experienced in closed needle biopsy. We wanted to compare the current standard method of obtaining pleural tissue by closed needle biopsy with this new technique and also determine its ease of use.

Physician-performed thoracoscopy can be used to obtain pleural and lung tissue4 and, under general

Conclusion

The thoracofiberscope can be used by the physician in the ward or clinic sideroom, with less equipment than that needed for rigid thoracoscopy and without serious complications. Although optical quality is not quite as good as in rigid thoracoscopy, a greater area of pleura can be seen from one entry site. Histologic yield may be better in malignant pleural disease than with closed Abram's needle biopsy, but yield could be improved by a larger biopsy channel.

References (11)

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The authors received no financial support for this study, however, Olympus Optical Co Ltd, Tokyo, Japan, provided the LTF Semi-Flexible Thoracofiberscope.

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