Diagnostic utility of medical thoracoscopy in peripheral parenchymal pulmonary lesions

IntroductionVisceral pleural biopsy and peripheral lung biopsy can be undertaken at the same time as parietal pleural biopsy during medical thoracoscopy, with or without coexistence of a pleural effusion with lung disease.ObjectiveTo assess the accuracy and safety of medical thoracoscopy for the evaluation of peripheral parenchymal pulmonary lesions.PatientsWe studied 15 patients with peripheral parenchymal pulmonary disease, the cause of which had not been determined after initial investigations, including needle biopsy and thoracocentesis if pleural effusion is present. Two patients have solitary peripheral lesions while thirteen have diffuse pathology. Seven patients have pleural effusion in addition to parenchymal lesions.MethodsOnly one patient had thoracoscopy under general anaesthesia while the remaining fourteen were given local anaesthesia with mild sedation. Visually directed biopsies were taken from the lung using electrocautery in all patients. Biopsies were taken also from the parietal pleura in only seven patients.MeasurementsWe recorded clinical characteristics, laboratory data, findings and duration of thoracoscopy, and any complications associated with the procedure.ResultsA definitive diagnosis was established in 12 patients: 4 patients had primary bronchogenic carcinoma while 5 patients had metastases. Only 3 patients had benign parenchymal disease. Overall, thoracoscopy had a sensitivity of 80% for the diagnosis of peripheral parenchymal pulmonary lesions. Thoracoscopy was well tolerated under local anaesthesia and entailed hospitalization for less than 48 h in most cases. No deaths occurred, although 6.7% of patients had major complications, and 20% had minor complications.ConclusionsAmong patients with peripheral parenchymal pulmonary lesions remaining undiagnosed after usual initial investigation and even transthoracic needle biopsies, thoracoscopy done under local anaesthesia is a rapid, safe, and well-tolerated procedure with an excellent diagnostic yield that is equivalent to that of thoracotomy.