6    Medical Thoracoscopy/Pleuroscopy in Research

Medical thoracoscopy/pleuroscopy (MT/P) is a valuable tool for research in pleural diseases. It allows macroscopic inspection of the whole pleural cavity, including the surface of the lungs, and selective sampling of biopsies from the pleura or lung under visual control; it thus can diagnose or exclude several pathologies with high sensitivity and specificity. MT/P is the pulmonologist’s gold standard for diagnosis of pleural effusions.

Research domains for MT/P in normal subjects include performance of pleural lavage in otherwise normal subjects undergoing MT/P for other reasons than pleuropulmonary disease (e.g., treatment of essential hyperhidrosis), which enables the examination of the normal pleura and its contents (Noppen et al. 2000; Noppen 2004a) and the examination of pleural changes in pleuropulmonary disease not associated with pleural effusions, such as spontaneous pneumothorax (De Smedt et al. 2004).

There are numerous examples of the research value of MT/P in the diagnosis of pleural effusions. Prospective studies have been performed in malignant pleural effusion (Loddenkemperetal. 1983a; Canto et al. 1985; Boutin and Rey 1993), which showed the high diagnostic yield compared with pleural cytology and closed needle biopsy. Prospective studies in tuberculous pleurisy have also shown the superiority of MT/P in comparison with pleural fluid examinations and closed pleural biopsies (Loddenkemper et al. 1978; Loddenkemper 1983b; Walzl et al. 1996; Diacon et al. 2003).

MT/P is also superior in the diagnosis of diffuse malignant mesothelioma (Boutin and Rey 1993). The technique of autofluorescence thoracoscopy has been evaluated for the improved detection of otherwise invisible pleural lesions (Chrysanthidis and Janssen 2005). MT/P allows better staging and has prognostic implications in malignant mesothelioma (Boutin et al. 1993 c). Narrow band imaging has also been applied to MT/P in order to facilitate the detection of otherwise invisible malignant lesions (Schönfeld et al. 2009; Ishida et al. 2009). MT/P allows the grading of pleural involvement, which is correlated with survival (Sanchez-Armengol and Rodriguez-Panadero 1993) and also with the success of talc pleurodesis (Rodriguez-Panadero and Antony 1997; Dresler et al. 2005; Antony et al. 2004). It also allows study of the mechanisms of talc pleurodesis in malignant pleural effusion (Nasreen et al. 2000, 2007; Antony et al. 2004). After several experimental animal studies, the safety of talc poudrage was demonstrated in a large prospective multicenter study (Janssen et al. 2007).

Research has been done on the role of MT/P in the management of pneumothorax (van de Brekel et al. 1993; Boutin et al. 1995a; Schramel et al. 1997; Tschopp et al. 2002, 2006), including the role of talc poudrage in comparison with other pleurodesis techniques (Boutin et al. 1995a; Schramel et al. 1997; Tschopp et al. 2002). New techniques under research include (fluorescein-enhanced) autofluorescence thoracoscopy in the study of spontaneous pneumothorax (Noppen et al. 2006) and exudative pleural effusion (Chrysanthidis and Janssen 2005).

Vansteenkiste and co-workers in a prospective study analyzed the quality and diagnostic value of lung biopsies for the diagnosis of interstitial lung disease (Vansteenkiste et al. 1999). Thoracoscopic autopsy has been compared with conventional autopsy and yielded excellent results (sensitivity of 87%) (Avrahami et al. 1995).

Research using thoracoscopy in animal experiments has been described in Chapter 5.

Future Areas of Research

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