You may have heard that many surgeries for lung cancer or small lung nodules are now done thoracoscopically, which is a “minimally invasive” procedure. In fact, in addition to treatment, thoracoscopy can be used as an examination to aid in the diagnosis of disease. But it is an invasive test. So what exactly does it do? Read this article and you will understand.
What is a thoracoscopy?
Thoracoscopy is a procedure in which a tiny medical camera is used to project the inside of the chest cavity onto a display screen using optical fibers. This is the same as putting the doctor’s eyes “inside” the patient’s chest, allowing a clear view of the tissue inside the chest cavity, including the entire chest wall, lung tissue, diaphragm, etc. The thoracoscopic field of view can be enlarged as needed to show the fine structure, which is clearer and more flexible than under the direct vision of the naked eye. When a “suspicious” lesion is encountered, the doctor can also take a sample and use it for pathological examination.
So, with thoracoscopy or surgery, the surgeon can find the subtle structures of the lesion more precisely and determine the extent of resection more accurately than with traditional open-heart surgery.
What conditions in lung cancer require thoracoscopy?
- Unexplained pleural effusion. For patients with lung cancer combined with pleural effusion, if it is not clear whether the effusion is related to lung cancer, or if the treatment is not effective and the effusion recurs, thoracoscopy is needed.
- Diagnosis of most benign or malignant pleural disease. The pleura is divided into a mural layer, which is the “lining” of the thorax, and a dirty layer, which covers the surface of the lung, and is often difficult to diagnose when disease occurs in these two thin structures. When lung cancer involves the pleura and cannot be clearly identified preoperatively, thoracoscopy is sometimes required.
- Biopsy for some diffuse lung disease. For example, the rare pulmonary lymphangioleiomyomatosis, in which lesions are present throughout the lung but just cannot be diagnosed, also requires the use of thoracoscopy. Some diffusely disseminated lung cancers require thoracoscopy to take a biopsy.
- Treatment of most malignant pleural effusions, benign recurrent pleural effusions, spontaneous pneumothorax, and other conditions. This is actually a treatment along with the examination to both see the lesion and treat it.
Which patients should not undergo thoracoscopy?
- Patients with severe cardiovascular disease;
- Patients with severe hypoxemia;
- Patients with bleeding disorders, or with a tendency to bleed;
- Patients who are taking some medications that increase the risk of bleeding (e.g., aspirin, warfarin, etc.);
- Patients who are extremely frail;
- Patients who have had previous pleurisy are also not candidates for thoracoscopy because of pleural cavity adhesions.
In summary, compared to imaging modalities such as CT and MRI, thoracoscopy is more intuitive and allows access to focal tissue for pathology, providing more accurate information for subsequent treatment. But it is, after all, an invasive test, which may cause some complications and is more expensive, and sometimes does not fully clarify the diagnosis. To do or not to do, you need to listen to your doctor’s advice in detail.
Co-reviewed by Dr. Tang Wenfang, Associate Chief Physician, Guangdong Provincial People’s Hospital, Guangdong Lung Cancer Institute, Liao Rijiang