Chest
Original Research: Disorders of the PleuraA Pilot Study of Autofluorescence in the Diagnosis of Pleural Disease
Section snippets
Patients
Eligible patients presented with an undiagnosed exudative pleural effusion after at least one thoracocentesis and were admitted to Beijing Chaoyang Hospital between August 2013 and February 2014. Patient age ranged from 18 to 90 years. Patients with multiple pleural adhesions, transudatory pleural effusions, respiratory failure, coagulation disorders, anesthetic allergy, pregnancy, or any other MT contraindications were excluded. All patients received thoracic ultrasonography, chest CT scans,
Equipment
The AFI videobronchoscope BF-F260 (the AFI system) was used as the fluorescence method during MT, whereas the flexirigid medical thoracoscope Olympus LTF-240 was used as a means of conventional white light mode control. The AFI system consists of three parts: an autofluorescence endoscope (BF-F260), a videoprocessor unit (EVIS LUCERA SPECTRUM [CV-260SL]; Olympus), and a xenon light source. An integrated filter enabled the selection of white light and excitation from the xenon light. The
Thoracoscopic Procedure
MT was performed in an endoscopy suite. For minimizing the visual bias, each procedure was completed by two pulmonologists working together. The patients were positioned on the nonaffected side, and a sterile field was prepared. The patients were given local anesthesia, staying conscious during the procedure. An entrance trocar was inserted into the thoracic cavity for inspection. After evacuating pleural effusions, the pleural cavity was first thoroughly inspected by conventional thoracoscope
Outcome Evaluation
The specimens were categorized as AFI positive or negative and WLT positive or negative. The pathologist was blinded to the categorization and assessed each specimen separately. The pathologic reports were classified as malignancy, TB, infection, nonspecific inflammation, and normal. In this study, true positive was defined as abnormal endoscopic findings along with pathologic examination identifying as malignancy, TB, or infection. False positive was defined as abnormal endoscopic findings
Results
Thirty-seven patients aged 22 to 85 years with undiagnosed exudative pleural effusions were enrolled, including 17 men and 20 women. Twenty patients had right-sided effusions, 16 had left-sided effusions, and one had bilateral effusions. Thirty-three patients received diagnoses, including 21 with malignancy, nine with tuberculous pleurisy, and three with infective pleurisy. Four patients did not receive a diagnosis because their pleural biopsy specimens indicated nonspecific inflammatory
Complications
No severe complications occurred in any patients studied. Minor postoperative complications included localized pain in two of the 37 patients (5.4%) and subcutaneous emphysema in another two patients (5.4%). No complication from the autofluorescence occurred. Furthermore, 5 to 10 min were required for additional fluorescence examination. This method proved to be as safe as the conventional thoracoscopy.
Discussion
Application of fluorescence in the diagnosis of pleural diseases was first reported in 2002 by Prosst et al,4 who developed an animal pleural carcinosis model of human adenocarcinoma and measured photosensitizer (5-aminolevulinic acid [5-ALA]) accumulations in the tumor by applying indirect spectrometry; it was 11 times higher than the normal tissues. Fluorescence detected 30% more pleural malignant lesions than conventional thoracoscopy. Another group showed similar findings in a pig model,5
Conclusions
To our knowledge, we are the first group to report on the application of the autofluorescence diagnostic method during MT. The advantages of autofluorescence lie in its extremely high sensitivity and NPV. Autofluorescence combined with white light is helpful in identifying microlesions and delineating pathologic margins. AFI also contributes to the precise staging of advanced lung cancer with pleural effusions. For patients with AFI-negative results, physicians should be careful when evaluating
Acknowledgments
Author contributions: F. W. and Z. T. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data collection and analysis. F. W. and Z. W. contributed to the data collection and analysis; F. W., Z. W., L. X., X. W., and Y. W. contributed to the MT procedure; F. W. contributed to the writing of the manuscript; Z. W. and Z. T. contributed to the review and editing of the manuscript; and L. X., X. W., and Y. W. contributed to
References (10)
- et al.
Diagnostic value of medical thoracoscopy in pleural disease: a 6-year retrospective study
Chest
(2002) - et al.
The role of Abrams percutaneous pleural biopsy in the investigation of exudative pleural effusions
Chest
(2006) - et al.
Effective detection of bronchial preinvasive lesions by a new autofluorescence imaging bronchovideoscope system
Lung Cancer
(2005) - et al.
5-Aminolevulinic acid-induced fluorescence diagnosis of pleural malignant tumor
Lung Cancer
(2011) - et al.
Fluorescence detection of pleural malignancies using 5-aminolaevulinic acid
Chest
(2006)
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Dr F. Wang is currently at the Department of Respiratory Medicine, Fuxing Hospital, Capital Medical University, Beijing, China.
Drs F. Wang and Z. Wang contributed equally to this manuscript.
FUNDING/SUPPORT: This study was supported by Beijing Municipal Science & Technology Commission [No. Z131107002213107].
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