Medical Thoracoscopy Safe and Effective for Mesothelioma Diagnosis

UK researchers say a minimally invasive procedure called medical thoracoscopy is safe and effective for diagnosing mesothelioma and treating its symptoms. 

The word comes from a large medical center in Northumberland. The UK has one of the highest rates of pleural mesothelioma in the world. Rates of pleural mesothelioma in Northumberland are especially high. 

Mesothelioma diagnosis usually requires a biopsy. The new study finds that medical thoracoscopy enabled “high diagnostic sensitivity” with few serious complications.  

Understanding Medical Thoracoscopy

Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating diseases affecting the pleura. The pleura is a membrane that surrounds the lung. People with mesothelioma and some other diseases can develop fluid between the pleura and the lungs. The fluid is called pleural effusion. 

Pleural effusion is very common with mesothelioma. Mesothelioma patients with pleural effusion have trouble breathing. They may also develop a cough and chest pain. Many have trouble lying down flat. 

Medical thoracoscopy gives doctors a way to look inside the chest wall at the pleura and at pleural effusions. They may use it to find the reason for the pleural effusions. They can also perform procedures or take tissue samples for biopsy. They can even administer medication to help keep the fluid from returning. 

Tracking the Success of the Procedure

Mesothelioma patients who have medical thoracoscopy can have general anesthesia or just moderate sedation. The new UK study focused on the approach that does not require general anesthesia. Instead, patients are sedated and doctors administer a local anesthetic to numb the area where they are working. This is called local anesthetic medical thoracoscopy or LAT. 

Between January 2010 and December 2018, 275 patients had LAT at the Northumberland hospital. Forty percent of them had pleural mesothelioma. The rest had lung cancer, breast cancer or pleuritis. 

Only 7 cases of cancer could not be diagnosed with medical thoracoscopy. That means it accurately pinpointed cancer 97.5 percent of the time.  

The complication rate was low. Three patients (1%) developed a pleural infection after the procedure. Four (1.4%) got an infection at the incision site. Nine patients (3.2%) had persistent air leaks and ten patients (3.6%) had subcutaneous emphysema. One patient developed a new tumor in the spot where the port was inserted. 

Patients stayed in the hospital after medical thoracoscopy for an average of 4 days. Only one patient died. 

“In this cohort, LAT was safe, effective, and enabled high diagnostic sensitivity,” writes Avinash Aujayeb, lead researcher on the study. 

But Dr. Aujayeb says there is still more to learn about medical thoracoscopy for people with mesothelioma and other conditions. Questions remain about how much sedation is ideal and how to use LAT with people who have indwelling pleural catheters. 

Sources:

Aujayeb, Avinash & Jackson, Karl, “A review of the outcomes of rigid medical thoracoscopy in a large UK district general hospital”, November 2020, Pleura and Peritoneum, eCollection, https://www.degruyter.com/document/doi/10.1515/pp-2020-0131/html