Application of Narrow-Band Imaging thoracoscopy in diagnosis of pleural diseases

ABSTRACT

Background

Patients with undiagnostic pleural effusions are routinely examined by conventional medical thoracoscopy under the white light (WL). The endoscopic appearance of pleural diseases under WL could be misleading. Narrow-Band Imaging (NBI) has been applied as an interesting and effective diagnostic tool for endoscopy. However, there is also controversy about its value in the application of thoracoscopy.

Objective

The objective of this study was to investigate the diagnostic value of NBI technology during thoracoscopy.

Methods

Patients with undiagnosed pleural effusions admitted to our hospital between September 2017 and September 2019 were enrolled. During the thoracoscopy, we performed WL mode first and then NBI. Pictures of endoscopic real-time lesions were recorded under two modes, and at least five pieces of tissue were taken, respectively, on pleura lesions. Biopsy specimens were respectively taken for pathologic analysis. Diagnostic sensitivity, specificity were calculated to compare with pathologic results.

Results

100 eligible patients were enrolled, including 63 with malignancy, 23 with tuberculous pleurisy, 3 with systemic disease and 11 with the negative condition. Compared with pathological results, the sensitivity of WL was 91.01%, and NBI 84.27%; while the specificity of WL was 27.27%, and NBI 81.82%. Compared NBI with WL, the former’s specificity is superior to the latter’s, which is statistically significant (P < 0.05).

Conclusions

The advantage of NBI lies in its high specificity. It’s useful to diagnose unknown pleural effusions in clinical practice. With better visualization of blood vessels, we can enhance the accuracy of biopsy and reduce the risk of unexpected bleeding arose from the biopsy.

KEYWORDS:

• Narrow Band Imaging
• thoracoscopy
• diagnosis
• pleural diseases

Acknowledgments

We thank Dr. Muchen, Li for data collection; Mulan Jin, MD, and her team of pathologists for their assistance in this study; Hong-jie Li and Zhan Lu for their assistance during the MT procedure.

Author contributions

Xinglu, Zhang contributed to integrate of the data and analysis and was a major contributor in writing the manuscript; Feng, Wang was in charge of study design and revised the manuscript. Zhaohui, Tong participated in the design of the study and revise the manuscript. All authors have read and approved the final manuscript.

Declaration of interest

The authors have no conflicts of interest to declare.

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

Declaration of financial/other relationships

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

We have registered this study with its registration number ChiCTR2000029440. The approved number of ethic committee was 2018-KE-322.

Additional information

Funding

Beijing Municipal Administration of Hospitals Clinical medicine Development of special funding support, code: XMLX201831.