An electrocautery pleural biopsy for the diagnosis of desmoplastic malignant mesothelioma during semirigid thoracoscopy

Our plain-English summary of An electrocautery pleural biopsy for the diagnosis of desmoplastic malignant mesothelioma during semirigid thoracoscopy, by S. Sasada, K. Kawahara, T. Iwasaki, et al (Journal of Thoracic Oncology, 2008).

The study

• Authors: S. Sasada, K. Kawahara, T. Iwasaki, T. Hirashima, T. Miyazawa
• Journal: Journal of Thoracic Oncology
• Published: 2008;3(7):803-4
• Type of article: Case report, Letter
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This was a letter to the editor describing one patient in Japan. The authors reported a 65-year-old man with a three-month history of chest pain whose chest scan showed fluid and thickening of the lining around the right lung (the pleura). Cell and bacterial tests on the fluid were negative. During semirigid thoracoscopy, in which a camera is passed into the chest under local anesthesia, the pleura was densely scarred. Standard flexible forceps could not grip it well, and the pieces they took were too small. The authors then used an insulation-tipped electric knife, a tool designed for stomach procedures, to cut out a circular piece of pleura 15 mm at its largest diameter. They reported no pleural pain or extensive bleeding. The authors described the findings in this sample as consistent with a definitive diagnosis of desmoplastic malignant mesothelioma, a rare type of malignant pleural mesothelioma. The patient received four cycles of pemetrexed chemotherapy and died of severe cardiac failure ten months after diagnosis. The authors called the method investigational and concluded that in this case they obtained a large enough biopsy safely. The letter did not mention asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (letter to the editor) describing an investigational biopsy technique
• Who was studied: one 65-year-old man with a 3-month history of chest pain, treated at Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Japan
• Main results:
  • Pleural fluid cytology and bacteriology were negative. The cytokeratin 21 level (56.5 ng/ml) was elevated.
  • Because of extensive fibrosis, standard flexible forceps could not adequately grasp the pleura.
  • Specimens taken with flexible forceps were too small.
  • The specimen cut with the insulation-tipped knife was of adequate size and kept the full thickness of the original tissue. It measured 15 mm at its largest diameter.
  • There was no pleural pain or extensive bleeding during the procedure.
  • Histopathology showed a prominent storiform collagen pattern and a lack of zonation. The authors described this as consistent with a definitive diagnosis of desmoplastic malignant mesothelioma.
  • The patient received four cycles of pemetrexed and died ten months after initial diagnosis of severe cardiac failure with pulmonary edema.
• The authors' conclusion: The authors concluded that with their investigational technique they hollowed out the hard, thickened pleura safely and obtained a biopsy large enough for diagnosis in this patient.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Biopsy, Desmoplastic Mesothelioma, Malignant Mesothelioma, Thoracoscopy.

Related studies

• Pleuroscopic punch biopsy using insulated-tip diathermic knife-2 for the diagnosis of desmoplastic malignant mesothelioma — K. Masai, S. Sasada, et al. (2013)
• Semi-Rigid Thoracoscopic Punch Biopsy Using a Hybrid Knife with a High-Pressure Water Jet for the Diagnosis of Pleural Effusions — Y. Yin, R. Eberhardt, et al. (2016)
• Diagnostic value of medical thoracoscopy in pleural disease: a 6-year retrospective study — F.X. Blanc, K. Atassi, et al. (2002)
• Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial — M. Metintas, G. Ak, et al. (2010)
• Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions in Denmark — F. Willendrup, U. Bodtger, et al. (2014)
• Utility of Site-Specific Biopsy for Diagnosis of Desmoplastic Malignant Mesothelioma — T. Sakai, K. Tane, et al. (2018)

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