Pleuroscopy in clinical evaluation and staging of lung cancer

The use of pleuroscopy in patients with bronchogenic carcinoma has not been reported previously. We performed this procedure in 45 lung cancer patients in whom pleural involvement was suspected. Pleural fluid or mestastases were found in 37 patients, 5 of whom had also major atelectasis due to bronchial obstruction by tumor. Neoplasm penetrating vital structures (aorta, brachial plexus) was found in 3 patients, tumor confining to resectable structures in 3; no pleural abnormalities were disclosed in 2. Based on these findings, 43 tumors were assigned stage III. Only on two occasions pleuroscopy did not aid staging. In 20 patients with massive pleural effusion causing dyspnea we insufflated talc in order to produce pleurodesis. This was fully successful in 16 patients, while in 2 the pleural cavity became only partially obliterated, with symptomatic relief. In 2 patients pleurodesis could not be evaluated because of early death caused by progression of cancer. Pleuroscopy is a highly informative procedure, applicable when involvement of pleura by lung cancer is suspected. It is helpful in clinical staging of the tumor and in assessment of its resectability, particularly in elderly, poor-risk patients. It provides the best way for talc insufflation when pleurodesis is indicated. Pleuroscopy should have an established place in the clinical evaluation and staging of lung cancer.