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Semin Respir Crit Care Med 2010; 31(6): 751-759
DOI: 10.1055/s-0030-1269835
© Thieme Medical Publishers

The Utility of Thoracoscopy in the Diagnosis and Management of Pleural Disease

Marc Noppen1
  • 1Interventional Endoscopy Clinic, University Hospital UZ Brussel, Brussels, Belgium
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Publication History

Publication Date:
06 January 2011 (online)

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ABSTRACT

Recurrent and persistent pleural exudates are common in clinical practice, and in a large number of patients, thoracocentesis and blind pleural biopsy procedures do not provide a definitive diagnosis. In the Western world, the majority of these exudates are malignant. Thoracoscopy today remains the gold standard technique in providing diagnosis and management in these cases. Other common indications include diagnosis and management of recurrent or refractory benign exudates or transudates, pleural based tumors and pleural thickening, selected cases of pleural empyema, and recurrent spontaneous primary and secondary pneumothorax. Major advantages of this technique are ease of application, high diagnostic accuracy and therapeutic efficacy, low cost, and excellent safety record comparable with flexible bronchoscopy. Thoracoscopy should be part of the routine training curriculum of respiratory physicians.

KEYWORDS

Thoracoscopy - pleuroscopy - pleural exudate - malignant pleural effusion - pneumothorax pleurodesis

REFERENCES

  • 1 Jacobeus H C. Uber die Möglichkeit, die Zystoskopie bei Untersuchung seröser Höhlungen anzuwenden.  Munch Med Wochenschr. 1910;  57 2090-2092
    PubMedSearch in Google Scholar
  • 2 Noppen M. Pleural biopsy and thoracoscopy.  Eur Respir Mon. 2010;  48 119-132
    PubMedSearch in Google Scholar
  • 3 Mathur P N, Loddenkemper R. Medical thoracoscopy: role in pleural and lung diseases.  Clin Chest Med. 1995;  16 487-496
    PubMedSearch in Google Scholar
  • 4 Prakash U B, Reiman H M. Comparison of needle biopsy with cytologic analysis for the evaluation of pleural effusion: analysis of 414 cases.  Mayo Clin Proc. 1985;  60 158-164
    CrossrefPubMedSearch in Google Scholar
  • 5 Diacon A H, Van de Wal B W, Wyser C et al.. Diagnostic tools in tuberculous pleurisy: a direct comparative study.  Eur Respir J. 2003;  22 589-591
    CrossrefPubMedSearch in Google Scholar
  • 6 Tomlinson J R, Sahn S A. Invasive procedures in the diagnosis of pleural disease.  Semin Respir Med. 1987;  9 31-36
    PubMedSearch in Google Scholar
  • 7 Canto A, Rivas J, Saumench J, Morera R, Moya J. Points to consider when choosing a biopsy method in cases of pleurisy of unknown origin.  Chest. 1983;  84 176-179
    CrossrefPubMedSearch in Google Scholar
  • 8 Maskell N A, Gleeson F V, Davies R J. Standard pleural biopsy versus CT-guided cutting-needle biopsy for diagnosis of malignant disease in pleural effusions: a randomised controlled trial.  Lancet. 2003;  361 1326-1330
    CrossrefPubMedSearch in Google Scholar
  • 9 Koegelenberg CF, Bolliger C T, Theron J et al.. Direct comparison of the diagnostic yield of ultrasound-assisted Abrams and Tru-Cut needle biopsies for pleural tuberculosis.  Thorax. 2010;  65 857-862
    CrossrefPubMedSearch in Google Scholar
  • 10 Villanueva A G, Beamis J F. Medical thoracoscopy: diagnosis of pleural pulmonary disorders. In: Beamis J F, Mathur P N, Mehta A C, eds. Interventional Pulmonary Medicine: Lung Biology in Health and Disease. New York: Marcel Dekker; 2004: 431-449
    Search in Google Scholar
  • 11 Baumann M H. Medical thoracoscopy: therapy for benign conditions. In: Beamis J F, Mathur P N, Mehta A C, eds. Interventional Pulmonary Medicine: Lung Biology in Health and Disease. New York: Marcel Dekker; 2004: 469-482
    Search in Google Scholar
  • 12 Janssen J P, Ramlal S, Mravunac M. The longterm follow-up of exudative pleural effusion after non-diagnostic thoracoscopy.  J Bronchology. 2004;  11 169-174
    PubMedSearch in Google Scholar
  • 13 Venekamp L N, Velkeniers B, Noppen M. Does ‘idiopathic pleuritis’ exist? Natural history of non-specific pleuritis diagnosed after thoracoscopy.  Respiration. 2005;  72 74-78
    CrossrefPubMedSearch in Google Scholar
  • 14 Wait M A, Sharma S, Hohn J, Dal Nogare A. A randomized trial of empyema therapy.  Chest. 1997;  111 1548-1551
    CrossrefPubMedSearch in Google Scholar
  • 15 Loddenkemper R. Thoracoscopy—state of the art.  Eur Respir J. 1998;  11 213-221
    CrossrefPubMedSearch in Google Scholar
  • 16 Chambers A, Routledge T, Dunning J, Scarci M. Is video-assisted thoracoscopic surgical decortication superior to open surgery in the management of adults with primary empyema?.  Interact Cardiovasc Thorac Surg. 2010;  11 171-177
    CrossrefPubMedSearch in Google Scholar
  • 17 Krenke K, Peradzyńska J, Lange J, Ruszczyński M, Kulus M, Szajewska H. Local treatment of empyema in children: a systematic review of randomized controlled trials.  Acta Paediatr. 2010;  May 3. [Epub ahead of print]
    PubMedSearch in Google Scholar
  • 18 Maskell N A, Davies C W, Nunn A J First Multicenter Intrapleural Sepsis Trial (MIST1) Group et al. U.K. controlled trial of intrapleural streptokinase for pleural infection.  N Engl J Med. 2005;  352 865-874
    CrossrefPubMedSearch in Google Scholar
  • 19 Vansteenkiste J, Verbeken E, Thomeer M, Van Haecke P, Eeckhout A V, Demedts M. Medical thoracoscopic lung biopsy in interstitial lung disease: a prospective study of biopsy quality.  Eur Respir J. 1999;  14 585-590
    CrossrefPubMedSearch in Google Scholar
  • 20 Light R W. Management of spontaneous pneumothorax.  Am Rev Respir Dis. 1993;  148 245-248
    CrossrefPubMedSearch in Google Scholar
  • 21 Sahn S A, Heffner J E. Spontaneous pneumothorax.  N Engl J Med. 2000;  342 868-874
    CrossrefPubMedSearch in Google Scholar
  • 22 Noppen M. Con: blebs are not the cause of primary spontaneous pneumothorax.  J Bronchol. 2002;  9 319-325
    CrossrefPubMedSearch in Google Scholar
  • 23 Ohata M, Suzuki H. Pathogenesis of spontaneous pneumothorax: with special reference to the ultrastructure of emphysematous bullae.  Chest. 1980;  77 771-776
    CrossrefPubMedSearch in Google Scholar
  • 24 Randomsky JBH, Hartel W. Pleuraporositat beim idiopatischen spontanpneumothorax.  Pneumologie. 1989;  43 250-253
    PubMedSearch in Google Scholar
  • 25 Hatz R A, Kaps M F, Meimarakis G, Loehe F, Müller C, Fürst H. Long-term results after video-assisted thoracoscopic surgery for first-time and recurrent spontaneous pneumothorax.  Ann Thorac Surg. 2000;  70 253-257
    CrossrefPubMedSearch in Google Scholar
  • 26 Körner H, Andersen K S, Stangeland L, Ellingsen I, Engedal H. Surgical treatment of spontaneous pneumothorax by wedge resection without pleurodesis or pleurectomy.  Eur J Cardiothorac Surg. 1996;  10 656-659
    CrossrefPubMedSearch in Google Scholar
  • 27 Loubani M, Lynch V. Video assisted thoracoscopic bullectomy and acromycin pleurodesis: an effective treatment for spontaneous pneumothorax.  Respir Med. 2000;  94 888-890
    CrossrefPubMedSearch in Google Scholar
  • 28 Horio H, Nomori H, Kobayashi R, Naruke T, Suemasu K. Impact of additional pleurodesis in video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax.  Surg Endosc. 2002;  16 630-634
    CrossrefPubMedSearch in Google Scholar
  • 29 Amjadi K, Alvarez G G, Vanderhelst E, Velkeniers B, Lam M, Noppen M. The prevalence of blebs or bullae among young healthy adults: a thoracoscopic investigation.  Chest. 2007;  132 1140-1145
    CrossrefPubMedSearch in Google Scholar
  • 30 Noppen M, Dekeukeleire T, Hanon S et al.. Fluorescein-enhanced autofluorescence thoracoscopy in patients with primary spontaneous pneumothorax and normal subjects.  Am J Respir Crit Care Med. 2006;  174 26-30
    CrossrefPubMedSearch in Google Scholar
  • 31 Vandermeulen L, Makris D, Mordon S et al.. Thoracoscopic findings and pharmacokinetics of inhaled fluorescein in a pig model.  Respiration. 2010;  80 228-235
    CrossrefPubMedSearch in Google Scholar
  • 32 Gotoh M, Yamamoto Y, Igai H, Chang S, Huang C, Yokomise H. Clinical application of infrared thoracoscopy to detect bullous or emphysematous lesions of the lung.  J Thorac Cardiovasc Surg. 2007;  134 1498-1501
    CrossrefPubMedSearch in Google Scholar
  • 33 Noppen M, Baumann M H. Pathogenesis and treatment of primary spontaneous pneumothorax: an overview.  Respiration. 2003;  70 431-438
    CrossrefPubMedSearch in Google Scholar
  • 34 Noppen M, De Keukeleire T. Pneumothorax.  Respiration. 2008;  76 121-127
    CrossrefPubMedSearch in Google Scholar
  • 35 Salati M, Brunelli A, Xiumè F et al.. Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax: clinical and economical analysis in comparison to the traditional approach.  Interact Cardiovasc Thorac Surg. 2008;  7 63-66
    CrossrefPubMedSearch in Google Scholar
  • 36 Pompeo E, Tacconi F, Mineo D, Mineo T C. The role of awake video-assisted thoracoscopic surgery in spontaneous pneumothorax.  J Thorac Cardiovasc Surg. 2007;  133 786-790
    CrossrefPubMedSearch in Google Scholar
  • 37 Noppen M, Schramel F. Pneumothorax.  Eur Respir Mon. 2002;  22 279-296
    PubMedSearch in Google Scholar
  • 38 Noppen M, Meysman M, d'Haese J et al.. Comparison of video-assisted thoracoscopic talcage for recurrent primary versus persistent secondary spontaneous pneumothorax.  Eur Respir J. 1997;  10 412-416
    CrossrefPubMedSearch in Google Scholar
  • 39 Munavvar M, Khan M A, Edwards J, Waqaruddin Z, Mills J. The autoclavable semirigid thoracoscope: the way forward in pleural disease?.  Eur Respir J. 2007;  29 571-574
    CrossrefPubMedSearch in Google Scholar
  • 40 Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions.  Cochrane Database Syst Rev. 2004;  (1) CD002916
    PubMedSearch in Google Scholar
  • 41 Janssen J P, Collier G, Astoul P et al.. Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study.  Lancet. 2007;  369 1535-1539
    CrossrefPubMedSearch in Google Scholar
  • 42 Gonzalez A V, Bezwada V, Beamis Jr J F, Villanueva A G. Lung injury following thoracoscopic talc insufflation: experience of a single North American center.  Chest. 2010;  137 1375-1381
    CrossrefPubMedSearch in Google Scholar
  • 43 Noppen M. Who's (still) afraid of talc?.  Eur Respir J. 2007;  29 619-621
    CrossrefPubMedSearch in Google Scholar
  • 44 Hunt I, Barber B, Southon R, Treasure T. Is talc pleurodesis safe for young patients following primary spontaneous pneumothorax?.  Interact Cardiovasc Thorac Surg. 2007;  6 117-120
    CrossrefPubMedSearch in Google Scholar
  • 45 Györik S, Erni S, Studler U, Hodek-Wuerz R, Tamm M, Chhajed P N. Long-term follow-up of thoracoscopic talc pleurodesis for primary spontaneous pneumothorax.  Eur Respir J. 2007;  29 757-760
    CrossrefPubMedSearch in Google Scholar

Marc NoppenM.D. Ph.D. 

Interventional Endoscopy Clinic, University Hospital UZ Brussel

101 Laarbeeklaan, B 1090 Brussels, Belgium

Email: marc.noppen@uzbrussel.be