Role of video-assisted thoracoscopy in patients with ovarian cancer and pleural effusion.
OBJECTIVE
To evaluate the feasibility of video-assisted thoracoscopy (VAT) for staging advanced ovarian cancer, to measure the performance of preoperative computed tomography (CT) for diagnosing pleural metastases, to assess the correlation between pleural and abdominal involvement, and to measure the impact of VAT on patient management.


METHODS
We retrospectively evaluated 16 VAT procedures in 15 patients with advanced ovarian malignancies and pleural effusions. The reason for VAT was either to evaluate unilateral or bilateral pleural effusions (n = 15) or to evaluate pleural metastases after neoadjuvant chemotherapy (n = 1). Preoperative CT was performed routinely, and findings were compared with those of VAT. The rates of involvement of the hepatic pedicle, mesentery, and right side of the diaphragm were compared with the rate of pleural involvement.


RESULTS
The right side of the chest was examined 12 times; and the left side, 4 times. There were no complications; 1 procedure was stopped because of ventilatory intolerance. Video-assisted thoracoscopy identified metastases smaller than 1 cm in 5 patients and larger than 1 cm in 2 additional patients; there was no evidence of pleural involvement in 6 patients. Computed tomography had 14% sensitivity and 25% specificity for pleural status determination, using VAT biopsy as the reference standard. Pleural involvement did not correlate with involvement of the hepatic pedicle, mesentery, or right side of the diaphragm.


CONCLUSIONS
Video-assisted thoracoscopy performs better than CT for evaluating pleural involvement in ovarian cancer. Video-assisted thoracoscopy supplies accurate data on thoracic involvement, which does not seem predictable from the peritoneal involvement. Video-assisted thoracoscopy may impact patient management.
Cohen-Mouly
Sandra
S
Service de Chirurgie Gynécologique et Oncologique, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
Badia
Alain
A
Bats
Anne-Sophie
AS
Barthes
Françoise
F
Bensaïd
Chérazade
C
Riquet
Marc
M
Lécuru
Fabrice
F
D000368:Aged; D001707:Biopsy, Needle; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016066:Pleural Effusion, Malignant / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010997:Pleural Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed