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Bruno Housset - One of the best experts on this subject based on the ideXlab platform.
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diagnostic value of medical Thoracoscopy in pleural disease a 6 year retrospective study
Chest, 2002Co-Authors: Francoisxavier Blanc, Kinan Atassi, J Bignon, Bruno HoussetAbstract:Study objectives Unlike thoracocentesis and closed pleural biopsy (CPB), medical Thoracoscopy permits biopsy with direct visualization. In a 6-year retrospective study of patients having undergone at least one medical Thoracoscopy, we analyzed the diagnostic yield of Thoracoscopy and its value in the management of pleural disease. Setting/patients From January 1, 1989, to December 31, 1994, 168 medical thoracoscopies were performed on 154 patients (123 men; mean age ± SE, 61 ± 1 years), of which 149 were diagnostic and 19 were indicated for therapeutic assessment in malignant mesothelioma (MM). Prior to Thoracoscopy, at least one CPB had been performed in 120 of 149 cases, yielding a diagnosis in 96 cases. Results Thoracoscopy challenged the CPB-based diagnosis in 43 of 96 cases. In 66 cases of nonspecific inflammation diagnosed by CPB, Thoracoscopy revealed MM in 16 cases, adenocarcinoma in 10 cases, undetermined carcinoma in 3 cases, and pleural tuberculosis in 3 cases. In 18 cases in which the CPB diagnosis was MM, Thoracoscopy, performed for precise staging, challenged the diagnosis in 4 cases. In 12 cases of carcinoma diagnosed by CPB, Thoracoscopy specified the histologic type in 7 cases. Thoracoscopic diagnoses were found to be erroneous in 10 of 149 cases, mainly owing to pleural adhesions that limited access to the pleural cavity. There was one Thoracoscopy-related death, one case of sepsis, and six cases of empyema. Conclusions Medical Thoracoscopy appears to be efficient and relatively safe in the management of pleural disease. Pleural adhesions can lower its diagnostic value.
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Diagnostic value of medical Thoracoscopy in pleural disease: A 6-year retrospective study
Chest, 2002Co-Authors: F. X. Blanc, Kinan Atassi, Bruno HoussetAbstract:STUDY OBJECTIVES: Unlike thoracocentesis and closed pleural biopsy (CPB), medical Thoracoscopy permits biopsy with direct visualization. In a 6-year retrospective study of patients having undergone at least one medical Thoracoscopy, we analyzed the diagnostic yield of Thoracoscopy and its value in the management of pleural disease. SETTING/PATIENTS: From January 1, 1989, to December 31, 1994, 168 medical thoracoscopies were performed on 154 patients (123 men; mean age +/- SE, 61 +/- 1 years), of which 149 were diagnostic and 19 were indicated for therapeutic assessment in malignant mesothelioma (MM). Prior to Thoracoscopy, at least one CPB had been performed in 120 of 149 cases, yielding a diagnosis in 96 cases. RESULTS: Thoracoscopy challenged the CPB-based diagnosis in 43 of 96 cases. In 66 cases of nonspecific inflammation diagnosed by CPB, Thoracoscopy revealed MM in 16 cases, adenocarcinoma in 10 cases, undetermined carcinoma in 3 cases, and pleural tuberculosis in 3 cases. In 18 cases in which the CPB diagnosis was MM, Thoracoscopy, performed for precise staging, challenged the diagnosis in 4 cases. In 12 cases of carcinoma diagnosed by CPB, Thoracoscopy specified the histologic type in 7 cases. Thoracoscopic diagnoses were found to be erroneous in 10 of 149 cases, mainly owing to pleural adhesions that limited access to the pleural cavity. There was one Thoracoscopy-related death, one case of sepsis, and six cases of empyema. CONCLUSIONS: Medical Thoracoscopy appears to be efficient and relatively safe in the management of pleural disease. Pleural adhesions can lower its diagnostic value.
Izidor Kern - One of the best experts on this subject based on the ideXlab platform.
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feasibility and safety of parietal pleural cryobiopsy during semi rigid Thoracoscopy
Clinical Respiratory Journal, 2016Co-Authors: Ales Rozman, Luka Camlek, Mateja Marc Malovrh, Izidor Kern, Nicolas SchonfeldAbstract:Background and Aims Performing pleural biopsies during semi-rigid Thoracoscopy is sometimes a difficult and time-consuming task because of the lack of mechanical power of dedicated flexible forceps in patients with thickened pleura. The purpose of this first ever pilot study was to test the feasibility of taking biopsy specimens by cryoprobe from the parietal pleura during semi-rigid Thoracoscopy. Our aim was also to assess the diagnostic value and quality of specimens obtained, morphological features, feasibility of immunohistochemistry staining and possibility of DNA isolation. The secondary aim was to evaluate safety, tolerability and duration of the procedure. Methods Fifteen patients with pleural effusion of unknown origin that underwent semi-rigid Thoracoscopy were included. Biopsies were obtained using a flexible autoclavable cryoprobe 20416-032 (Erbokryo CA, ERBE, Tubingen, Germany) 2.4 mm in diameter and a semi-rigid autoclavable Olympus LTF-160 (Olympus, Tokyo, Japan) thoracoscope. Results Tissue samples were obtained from 14 patients (93.3%), three from each. Of the samples, 81% were easily interpretable and 19% were interpretable with some difficulty by the pathologist. The samples were of good quality, with the level of artifacts below 25%. The specimens were adequate for histological diagnosis, immunohistochemical staining and DNA isolation. There were no moderate or major bleeding problems after the biopsies; two patients experienced pain. The median duration of three cryobiopsies (per patient) was 4 min (range 3–6 min). Conclusions Cryobiopsy during semi-rigid Thoracoscopy appears worth to be evaluated in a larger prospective multicenter trial as our preliminary data were promising for efficacy and safety.
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rigid versus semi rigid Thoracoscopy for the diagnosis of pleural disease a randomized pilot study
Respirology, 2013Co-Authors: Ales Rozman, Luka Camlek, Mateja Marcmalovrh, Nadja Triller, Izidor KernAbstract:Background and objective Thoracoscopy with a semi-rigid instrument is a recent technique successfully used for diagnosing pleural diseases. However, there are concerns about the diagnostic adequacy of biopsy samples obtained by semi-rigid procedures when compared with rigid Thoracoscopy. The purpose of this study was to compare the size, quality and diagnostic adequacy of biopsy specimens obtained at semi-rigid and rigid Thoracoscopy in a prospective, randomized fashion. Methods Patients with pleural effusion of unknown origin and/or pleural irregularities suspicious for pleural malignancy were included after less invasive means of diagnosis had failed. All procedures were performed under local anaesthesia with intravenous sedation/analgesia with a single point of entry. Patients were randomly assigned to a rigid instrument procedure (Olympus EndoEYE WA50120A, forceps) or semi-rigid instrument procedure (Olympus LTF-160, FB-55CR-1 forceps). Results Eighty-four patients were randomized. Five of them were excluded because of lack of pleural space. Thirty-eight patients were assigned to a rigid and 41 to a semi-rigid procedure, with mean follow up 24.1 (±8.1) months after the procedure. The average size of the sample obtained by rigid Thoracoscopy was 24.7 mm2 (±12.9), and 11.7 mm2 (±7.6) by semi-rigid Thoracoscopy. There were no differences in the quality and interpretability of the specimens assessed by the pathologist. The diagnostic accuracy was 100% for the rigid procedure and 97.6% for the semi-rigid procedure. Conclusions The samples obtained by semi-rigid Thoracoscopy were smaller, but of adequate quality. The diagnostic accuracy was comparable with that of rigid Thoracoscopy in the evaluation of pleural disease.
Ales Rozman - One of the best experts on this subject based on the ideXlab platform.
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feasibility and safety of parietal pleural cryobiopsy during semi rigid Thoracoscopy
Clinical Respiratory Journal, 2016Co-Authors: Ales Rozman, Luka Camlek, Mateja Marc Malovrh, Izidor Kern, Nicolas SchonfeldAbstract:Background and Aims Performing pleural biopsies during semi-rigid Thoracoscopy is sometimes a difficult and time-consuming task because of the lack of mechanical power of dedicated flexible forceps in patients with thickened pleura. The purpose of this first ever pilot study was to test the feasibility of taking biopsy specimens by cryoprobe from the parietal pleura during semi-rigid Thoracoscopy. Our aim was also to assess the diagnostic value and quality of specimens obtained, morphological features, feasibility of immunohistochemistry staining and possibility of DNA isolation. The secondary aim was to evaluate safety, tolerability and duration of the procedure. Methods Fifteen patients with pleural effusion of unknown origin that underwent semi-rigid Thoracoscopy were included. Biopsies were obtained using a flexible autoclavable cryoprobe 20416-032 (Erbokryo CA, ERBE, Tubingen, Germany) 2.4 mm in diameter and a semi-rigid autoclavable Olympus LTF-160 (Olympus, Tokyo, Japan) thoracoscope. Results Tissue samples were obtained from 14 patients (93.3%), three from each. Of the samples, 81% were easily interpretable and 19% were interpretable with some difficulty by the pathologist. The samples were of good quality, with the level of artifacts below 25%. The specimens were adequate for histological diagnosis, immunohistochemical staining and DNA isolation. There were no moderate or major bleeding problems after the biopsies; two patients experienced pain. The median duration of three cryobiopsies (per patient) was 4 min (range 3–6 min). Conclusions Cryobiopsy during semi-rigid Thoracoscopy appears worth to be evaluated in a larger prospective multicenter trial as our preliminary data were promising for efficacy and safety.
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rigid versus semi rigid Thoracoscopy for the diagnosis of pleural disease a randomized pilot study
Respirology, 2013Co-Authors: Ales Rozman, Luka Camlek, Mateja Marcmalovrh, Nadja Triller, Izidor KernAbstract:Background and objective Thoracoscopy with a semi-rigid instrument is a recent technique successfully used for diagnosing pleural diseases. However, there are concerns about the diagnostic adequacy of biopsy samples obtained by semi-rigid procedures when compared with rigid Thoracoscopy. The purpose of this study was to compare the size, quality and diagnostic adequacy of biopsy specimens obtained at semi-rigid and rigid Thoracoscopy in a prospective, randomized fashion. Methods Patients with pleural effusion of unknown origin and/or pleural irregularities suspicious for pleural malignancy were included after less invasive means of diagnosis had failed. All procedures were performed under local anaesthesia with intravenous sedation/analgesia with a single point of entry. Patients were randomly assigned to a rigid instrument procedure (Olympus EndoEYE WA50120A, forceps) or semi-rigid instrument procedure (Olympus LTF-160, FB-55CR-1 forceps). Results Eighty-four patients were randomized. Five of them were excluded because of lack of pleural space. Thirty-eight patients were assigned to a rigid and 41 to a semi-rigid procedure, with mean follow up 24.1 (±8.1) months after the procedure. The average size of the sample obtained by rigid Thoracoscopy was 24.7 mm2 (±12.9), and 11.7 mm2 (±7.6) by semi-rigid Thoracoscopy. There were no differences in the quality and interpretability of the specimens assessed by the pathologist. The diagnostic accuracy was 100% for the rigid procedure and 97.6% for the semi-rigid procedure. Conclusions The samples obtained by semi-rigid Thoracoscopy were smaller, but of adequate quality. The diagnostic accuracy was comparable with that of rigid Thoracoscopy in the evaluation of pleural disease.
Ritesh Agarwal - One of the best experts on this subject based on the ideXlab platform.
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a randomized trial comparing the diagnostic yield of rigid and semirigid Thoracoscopy in undiagnosed pleural effusions
Respiratory Care, 2014Co-Authors: Sahajal Dhooria, Navneet Singh, Ashutosh N Aggarwal, Dheeraj Gupta, Ritesh AgarwalAbstract:BACKGROUND: Thoracoscopic pleural biopsy increases the diagnostic yield of pleural effusions undiagnosed after thoracentesis and is superior to closed pleural biopsy. Medical Thoracoscopy can be performed using the rigid thoracoscope or the semirigid thoracoscope (pleuroscope). In this randomized trial, we compare the efficacy and safety of the 2 thoracoscopes. METHODS: Subjects with undiagnosed exudative pleural effusions were randomly assigned to undergo pleural biopsy with either the rigid or the semirigid thoracoscope. The primary outcome was the diagnostic yield of the procedure, while the secondary outcomes were requirement of sedative/analgesic agents, scar size, biopsy sample size, and the operator's view of the procedure. RESULTS: Of the 145 screened subjects with exudative pleural effusions, 90 were randomized to undergo Thoracoscopy with the 2 thoracoscopes ( n = 45 each). The diagnostic yield of rigid Thoracoscopy was superior to semirigid Thoracoscopy (97.8% vs 73.3%, P = .002) on an intention-to-treat analysis but was similar (100% vs 94.3%, P = .18) in those with successful biopsy. The requirement of sedative/analgesic agents was higher in the rigid Thoracoscopy arm. The scar size was slightly larger (mean ± SD, 23.1 ± 4 vs 18.7 ± 3.2 mm, P = .0001), whereas the biopsy sample size was distinctly larger in the rigid arm (mean ± SD, 13.9 ± 4.4 vs 4.4 ± 1.4 mm, P = .001). The operator-rated visual analog scale score for the ease of taking a biopsy sample was significantly higher with the rigid instrument (mean ± SD, visual analog scale 86 ± 12 vs 79 ± 12 mm, P = .01), while the quality of image was superior in the semirigid arm (mean ± SD, visual analog scale 88 ± 7 vs 92 ± 5 mm, P = .002). The number of complications were similar in the 2 groups. CONCLUSIONS: Rigid Thoracoscopy was found to be superior to semirigid Thoracoscopy overall, but the diagnostic yield was similar if pleural biopsy could be successfully performed. Due to the small sample size, a larger study is required to define the usefulness and choice between the 2 procedures. (ClinicalTrials.gov registration [NCT01726556][1]) [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01726556&atom=%2Frespcare%2F59%2F5%2F756.atom
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diagnostic accuracy and safety of semirigid Thoracoscopy in exudative pleural effusions a meta analysis
Chest, 2013Co-Authors: Ritesh Agarwal, Ashutosh N Aggarwal, Dheeraj GuptaAbstract:Background The usefulness of semirigid Thoracoscopy in undiagnosed exudative pleural effusions (EPEs) has been variably reported in different studies. Herein, we perform a systematic review and meta-analysis to estimate the overall diagnostic yield and safety of semirigid Thoracoscopy in EPE. Methods We searched the PubMed and EMBASE databases for studies reporting the outcomes of semirigid Thoracoscopy in EPE. The quality of studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The yield of semirigid Thoracoscopy was analyzed by calculating the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic OR (DOR) for each study and pooling the study results using a random effects model. Heterogeneity and publication bias were assessed for individual outcomes. Sensitivity analysis was performed to explore the potential causes of heterogeneity. Results Our search yielded 17 studies (755 patients with undiagnosed EPE). The sensitivity, specificity, PLR, NLR, and DOR of semirigid Thoracoscopy was 91%, 100%, 4.92, 0.08, and 102.28, respectively. The area under the curve for the summary receiver operating characteristic curve was 0.93. There were negligible complications and no mortality. There was evidence of heterogeneity, which significantly decreased on sensitivity analysis after exclusion of smaller ( Conclusions Semirigid Thoracoscopy is an efficacious and safe procedure in diagnosis of EPE. Because of the small sample size, larger well-designed trials are required to confirm the results of this study. There is also a need for head-to-head comparison of semirigid and rigid Thoracoscopy.
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medical Thoracoscopy for undiagnosed pleural effusions experience from a tertiary care hospital in north india
The Indian journal of chest diseases & allied sciences, 2011Co-Authors: Vamsi K Mootha, Navneet Singh, Ashutosh N Aggarwal, Ritesh Agarwal, D K Gupta, Surinder K JindalAbstract:Background and Aims. Medical Thoracoscopy, also called pleuroscopy, has received renewed interest in the recent past for diagnostic as well as therapeutic uses. In this study, we describe our experience with Thoracoscopy for undiagnosed pleural effusions. Methods. In a retrospective analysis of thoracoscopic procedures we performed between January 2007 and December 2008, yield of thoracoscopic pleural biopsy for achieving a diagnosis in undiagnosed pleural effusions, defined as pleural effusions with adenosine deaminase (ADA) levels less than 70 IU/L and negative pleural fluid cytology for malignancy on three occasions was evaluated. Complications of Thoracoscopy were also analysed. Results. Overall diagnostic yield of thoracoscopic pleural biopsy was 74.3% in patients with undiagnosed pleural effusions. Pleural malignancy was diagnosed in 48.6% of patients. There was only one case of mesothelioma and the rest were due to pleural metastasis. Lung cancer and breast cancer were the most common sites of primary malignancy. Tuberculosis was diagnosed with pleural biopsy in 22.8% of patients. We had low complication rate after Thoracoscopy. Only two cases of empyema were observed. Conclusion. Medical Thoracoscopy is a safe procedure and has good diagnostic yield in patients with undiagnosed pleural effusions. [Indian J Chest Dis Allied Sci 2011;53:21-24]
Dheeraj Gupta - One of the best experts on this subject based on the ideXlab platform.
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a randomized trial comparing the diagnostic yield of rigid and semirigid Thoracoscopy in undiagnosed pleural effusions
Respiratory Care, 2014Co-Authors: Sahajal Dhooria, Navneet Singh, Ashutosh N Aggarwal, Dheeraj Gupta, Ritesh AgarwalAbstract:BACKGROUND: Thoracoscopic pleural biopsy increases the diagnostic yield of pleural effusions undiagnosed after thoracentesis and is superior to closed pleural biopsy. Medical Thoracoscopy can be performed using the rigid thoracoscope or the semirigid thoracoscope (pleuroscope). In this randomized trial, we compare the efficacy and safety of the 2 thoracoscopes. METHODS: Subjects with undiagnosed exudative pleural effusions were randomly assigned to undergo pleural biopsy with either the rigid or the semirigid thoracoscope. The primary outcome was the diagnostic yield of the procedure, while the secondary outcomes were requirement of sedative/analgesic agents, scar size, biopsy sample size, and the operator's view of the procedure. RESULTS: Of the 145 screened subjects with exudative pleural effusions, 90 were randomized to undergo Thoracoscopy with the 2 thoracoscopes ( n = 45 each). The diagnostic yield of rigid Thoracoscopy was superior to semirigid Thoracoscopy (97.8% vs 73.3%, P = .002) on an intention-to-treat analysis but was similar (100% vs 94.3%, P = .18) in those with successful biopsy. The requirement of sedative/analgesic agents was higher in the rigid Thoracoscopy arm. The scar size was slightly larger (mean ± SD, 23.1 ± 4 vs 18.7 ± 3.2 mm, P = .0001), whereas the biopsy sample size was distinctly larger in the rigid arm (mean ± SD, 13.9 ± 4.4 vs 4.4 ± 1.4 mm, P = .001). The operator-rated visual analog scale score for the ease of taking a biopsy sample was significantly higher with the rigid instrument (mean ± SD, visual analog scale 86 ± 12 vs 79 ± 12 mm, P = .01), while the quality of image was superior in the semirigid arm (mean ± SD, visual analog scale 88 ± 7 vs 92 ± 5 mm, P = .002). The number of complications were similar in the 2 groups. CONCLUSIONS: Rigid Thoracoscopy was found to be superior to semirigid Thoracoscopy overall, but the diagnostic yield was similar if pleural biopsy could be successfully performed. Due to the small sample size, a larger study is required to define the usefulness and choice between the 2 procedures. (ClinicalTrials.gov registration [NCT01726556][1]) [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01726556&atom=%2Frespcare%2F59%2F5%2F756.atom
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diagnostic accuracy and safety of semirigid Thoracoscopy in exudative pleural effusions a meta analysis
Chest, 2013Co-Authors: Ritesh Agarwal, Ashutosh N Aggarwal, Dheeraj GuptaAbstract:Background The usefulness of semirigid Thoracoscopy in undiagnosed exudative pleural effusions (EPEs) has been variably reported in different studies. Herein, we perform a systematic review and meta-analysis to estimate the overall diagnostic yield and safety of semirigid Thoracoscopy in EPE. Methods We searched the PubMed and EMBASE databases for studies reporting the outcomes of semirigid Thoracoscopy in EPE. The quality of studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The yield of semirigid Thoracoscopy was analyzed by calculating the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic OR (DOR) for each study and pooling the study results using a random effects model. Heterogeneity and publication bias were assessed for individual outcomes. Sensitivity analysis was performed to explore the potential causes of heterogeneity. Results Our search yielded 17 studies (755 patients with undiagnosed EPE). The sensitivity, specificity, PLR, NLR, and DOR of semirigid Thoracoscopy was 91%, 100%, 4.92, 0.08, and 102.28, respectively. The area under the curve for the summary receiver operating characteristic curve was 0.93. There were negligible complications and no mortality. There was evidence of heterogeneity, which significantly decreased on sensitivity analysis after exclusion of smaller ( Conclusions Semirigid Thoracoscopy is an efficacious and safe procedure in diagnosis of EPE. Because of the small sample size, larger well-designed trials are required to confirm the results of this study. There is also a need for head-to-head comparison of semirigid and rigid Thoracoscopy.
