Evaluation of a new fiberscope for pleuroscopy under local anesthesia

Pleuroscopy under local anesthesia is performed by physicians in case with unexplained pleural effusion. There are limits to the bending angle and image resolution of conventional fiberscopes. Olympus Corporation and 4 Japanese institutions, including our hospital, developed a new pleuroscope for use under local anesthesia. Compared to the conventional pleuroscope (LTF-260; Olympus, Japan), the new pleuroscope (LTF-Y0032; Olympus, Japan) comes with an improved bending angle from 160 degrees to 180 degrees, and the internal diameter from 2.8mm to 3.0mm. The quality of images has also been improved. We evaluated the new pleuroscope clinically. The study population comprised 30 patients with pleural effusion of unknown etiology at our hospital, who underwent pleuroscopy using the new pleuroscope from December 2016 to January 2019. The patients included 21 men and 9 women (median age, 76 years) with 18 right and 12 left pleural effusions. In the final diagnosis, there were 17 cases of malignant disease (10 cases of pleural metastasis of lung cancer, 4 cases of malignant pleural mesothelioma, 3 cases of malignant lymphoma), and 13 cases of benign disease (4 cases of pyothorax, 4 cases of nonspecific pleurisy, 2 cases of tuberculous pleurisy, 2 cases of asbestos-related pleurisy and 1 case of IgG4-related disease). In one case of mesothelioma, the lesion was confined to a part of the pleura that cannot be observed with conventional pleuroscope, but it could be visualized by bending the new pleuroscope by 180 degrees. The new pleuroscope has an improved bending angle, image quality and channel inner diameter. The improved bending angle is likely to minimize the blind spot, improving the diagnostic rate.