Thoracoscopy in the Early Diagnosis of Malignant Pleural Effusions

Summary

In order to achieve an early diagnosis of carcinomatous pleural effusions, cytologic studies, effective in 24 per cent of our cases, are carried out. The needle biopsy using the Abrams' trocar is positive in 54 per cent: initially, cancer is confined to restricted areas of the pleura, and thus a blind technique like Abrams' biopsy is not a good investigation. A new cold-light thoracoscope, designed in collaboration with Wolf & Co. has been used since 1978. The external diameter of the telescope is 7 mm. A double-spoon-shaped biopsy forceps for parietal pleura, a cutting biopsy forceps for visceral pleura and lung, and a coagulating device to manage bleeding are used. As many biopsies as necessary can be carried out; frozen-section examination may supply an accurate diagnosis during the thoracoscopy. The investigation is usually performed under general anesthesia and tracheal intubation. When necessary, insufflation of air under positive pressure can collapse the lung and permit a more comprehensive view of the pleural space. Photographs can easily be taken with a 135 mm lens, and 16 mm films with a 65 mm lens. Out of a consecutive series of 239 thoracoscopies, 45 patients underwent thoracoscopy with this new apparatus for a carcinomatous pleural effusion. An accurate histopathological diagnosis was found in 43: 6/7 mesotheliomas and 37/38 metastatic pleural tumors. In four patients cancerous nodules were very rare and small, and a diagnosis was made at a very early stage of cancer. We conclude that thoracoscopy is the most effective form of investigation for securing the diagnosis of cancer in pleural effusions.

Key words:

Cancer - Mesothelioma - Pleural effusions - Thoracoscopy - Pleural biopsy