Autofluorescence imaging-assisted medical thoracoscopy in the diagnosis of malignant pleural disease

Feng Wang; Lefei Zhou; Zhen Wang; Lili Xu; Yanbing Wu; Xue Li; Xiaojian Qiu; Songlin Zhao; Yushan Zheng; Zhiguo Jiang; Huanzhong Shi; Zhaohui Tong

doi:10.1016/j.rmed.2023.107114

Autofluorescence imaging-assisted medical thoracoscopy in the diagnosis of malignant pleural disease

Respir Med. 2023 Feb:207:107114. doi: 10.1016/j.rmed.2023.107114. Epub 2023 Jan 3.

Authors

Feng Wang¹, Lefei Zhou¹, Zhen Wang¹, Lili Xu¹, Yanbing Wu¹, Xue Li², Xiaojian Qiu³, Songlin Zhao⁴, Yushan Zheng⁵, Zhiguo Jiang⁵, Huanzhong Shi¹, Zhaohui Tong⁶

Affiliations

¹ Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
² Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
³ Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁴ Department of Respiratory and Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
⁵ Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China.
⁶ Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China. Electronic address: tongzhaohuicy@sina.com.

PMID: 36608860
DOI: 10.1016/j.rmed.2023.107114

Abstract

Background: Medical thoracoscopy (MT) does not always provide a conclusive diagnosis of pleural diseases because the endoscopic appearance of pleural diseases can be misleading. Autofluorescence imaging (AFI) is an effective assistive diagnostic tool. However, its clinical application for pleural disease remains controversial.

Objectives: This prospective study evaluated the clinical usefulness of AFI-assisted MT for diagnosis of malignant pleural diseases.

Methods: Patients with unexplained pleural effusion admitted to our clinics between December 2018 and September 2021 were enrolled. We performed white-light thoracoscopy (WLT) first, and then AFI, during MT. Images of endoscopic real-time lesions were recorded under both modes. Pleural biopsy specimens were analyzed pathologically. Between-groups differences in diagnostic sensitivity, specificity, positive-predictive value (PPV), and negative-predictive value (NPV) were assessed using 95% confidence intervals (CI). Receiver operating characteristic curves and decision curve analyses were employed to analyze the diagnostic efficiency of these two modes.

Results: Of 126 eligible patients, 73 cases were diagnosed with malignant pleural disease. A total of 1292 biopsy specimens from 492 pleural sites were examined for pathological changes. The diagnostic sensitivity, PPV, and NPV of AFI were 99.7%, 58.2%, and 99.2%, respectively. AFI was significantly superior to WLT, which had a sensitivity of 79.7%, PPV of 50.7%, and NPV of 62.8%. Subgroup analysis showed that the AFI type III pattern was significantly more specific for pleural malignant disease than that of WLT.

Conclusions: AFI could further improve the diagnostic efficacy of MT by providing better visualization, convenience, and safety.

Keywords: Autofluorescence endoscopy; Medical thoracoscopy; Pleural biopsy; Pleural diseases.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Neoplasms*
Optical Imaging / adverse effects
Pleura / diagnostic imaging
Pleura / pathology
Pleural Diseases* / pathology
Pleural Effusion* / etiology
Prospective Studies
Syndrome
Thoracoscopy