Investigation of pleural effusion: an evaluation of the new Olympus LTF semiflexible thoracofiberscope and comparison with Abram's needle biopsy.
OBJECTIVE
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.


METHODS
Twenty-four patients with pleural effusion were investigated.


METHODS
Scottish University Hospital.


METHODS
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.


CONCLUSIONS
The LTF thoracoscope allows excellent pleural access but a larger biopsy channel (currently 2 mm) might increase the accuracy of diagnosis.
Department of Respiratory Medicine, West Glasgow Hospitals University NGS Trust, Glasgow, UK.
A N
AN
McLean
S R
SR
Bicknell
L G
LG
McAlpine
A J
AJ
Peacock
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000772:Anesthesia, Local; D001285:Atropine / Q000008:administration & dosage; D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods*; D020680:Bronchoscopes; D004867:Equipment Design; D005069:Evaluation Studies as Topic; D005260:Female; D005336:Fiber Optic Technology / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation; D009892:Opium / Q000627:therapeutic use; D010996:Pleural Effusion / Q000473:pathology*; D016066:Pleural Effusion, Malignant / Q000473:pathology; D018583:Pliability; D011229:Preanesthetic Medication; D012680:Sensitivity and Specificity; D020708:Thoracoscopes
D000759:Adjuvants, Anesthesia; D000701:Analgesics, Opioid; D001285:Atropine; D009892:Opium