PP15 EXPANDING DIAGNOSTIC HORIZONS ON AN ISLAND IN BORNEO: A DISTRICT’S EXPERIENCE OF FLEXIBLE BRONCHOSCOPE-GUIDED MEDICAL PLEUROSCOPY

Pin Jin Yong¹, Guong Zhi Chan¹, Hema Yamini²

¹ Hospital Labuan, Wilayah Persekutuan Labuan, Malaysia
² Hospital Queen Elizabeth, Kota Kinabalu, Malaysia

Background
Access to advanced pulmonary diagnostics is challenging in resource-limited regions of Malaysian Borneo. Our hospital, located on an island approximately 200 km from the nearest tertiary centre - with patient transfers necessitating a combined sea and land journey - is an obstacle that delays diagnosis and treatment. Although medical pleuroscopy using a semi-rigid or rigid thoracoscope is the gold standard for elucidating pleural effusion etiology, it demands specialised equipment and expertise that our centre lacks. This study evaluates the feasibility, safety and diagnostic yield of an alternative approach - performing medical pleuroscopy with a flexible bronchoscope, a tool already presents in our hospital - to bridge the gap between current limitations and the growing demand for prompt, accurate diagnosis of pleural pathology.

Methodology
We conducted a retrospective, comparative analysis of 10 adults admitted to Hospital Labuan between August 2024 to June 2025 with unexplained unilateral exudative pleural effusion, who then underwent flexible bronchoscope-guided pleuroscopy under conscious sedation at our centre. 

Results
Pleuroscopy findings revealed a spectrum of abnormalities, including malignant-appearing nodules and masses, miliary fibrinous nodules with adhesions suggestive of tuberculosis, and non-specific inflammatory changes in others. Targeted biopsy yielded a definitive diagnosis in 70% of patients - 3 patients with malignant pleural effusion, 2 patients with pleural tuberculosis and 2 patients with non-specific inflammation due to end-stage renal failure and systemic lupus erythematosus respectively. Further analysis indicated that pleural tissue GeneXpert was positive in only one of five tuberculosis patients. Two patients developed subcutaneous emphysema; no other major complications occurred. The median interval from presentation to pleuroscope was 3 days, with a mean time to definitive diagnosis of 11 days. 

Conclusion
Flexible bronchoscope-guided pleuroscopy, performed by trained physicians in resource-limited settings, is a feasible, safe, and effective alternative to conventional pleuroscopy when specialised personnel and equipment are unavailable. Our analysis demonstrates that innovative use of available instruments can overcome geographic challenges and enhance patient care.