Advances in Medical Thoracoscopy/Pleuroscopy and Innovations in Pleural Biopsy Techniques

Conventional diagnostic methods for malignant pleural effusion, including thoracentesis and blind pleural biopsy, have shown unsatisfactory diagnostic rates, particularly for pleural mesothelioma, where the risk of misdiagnosis remains significant. Medical thoracoscopy/pleuroscopy (MT/P) has transformed pleural disease diagnosis by allowing direct visualization and targeted biopsy of pleural lesions, thereby greatly improving diagnostic accuracy. Recent developments include a new semi-flexible thoracic videoscope (LTF-H290, Olympus) featuring enhanced high-definition imaging, a larger 3.0 mm working channel, narrow band imaging capability for detailed vascular observation, and improved flexibility with 180-degree bending angles for accessing previously difficult areas. Standard pleural biopsy primarily uses alligator forceps targeting the parietal pleura, with adequate tissue collection essential for both pathological diagnosis and biomarker analysis. For challenging cases involving thickened or fibrotic pleura, specialized full-thickness biopsy techniques have been developed. Two innovative approaches show particular promise: (1) High-frequency knife (IT knife) biopsy enables full-thickness pleural tissue collection from thickened lesions, proving especially useful for distinguishing fibrous pleurisy from desmoplastic pleural mesothelioma; (2) Cryoprobe biopsy uses carbon dioxide cooling to −89°C, allowing the collection of large tissue specimens with minimal crushing artifact, which is advantageous for biomarker testing and definitive mesothelioma diagnosis. These advances in MT/P technology and specialized biopsy techniques address the inherent challenges of pleural tissue thickening and fibrosis, significantly improving diagnostic capability for malignant pleural diseases while enabling comprehensive biomarker analysis essential for modern lung cancer management.