Flex-rigid pleuroscopic biopsy with the SB knife Jr is a novel technique for diagnosis of malignant or benign fibrothorax

Our plain-English summary of Flex-rigid pleuroscopic biopsy with the SB knife Jr is a novel technique for diagnosis of malignant or benign fibrothorax, by X.B. Wang, Y. Yin, Y. Miao, et al (Journal of Thoracic Disease, 2016).

The study

• Authors: X.B. Wang, Y. Yin, Y. Miao, R. Eberhardt, G. Hou, F.J. Herth, J. Kang
• Journal: Journal of Thoracic Disease
• Published: 2016;8(11):E1555-E1559
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Diagnosing pleural effusion is challenging, especially in patients with malignant or benign fibrothorax, which is difficult to sample using standard flexible forceps (SFF) via flex-rigid pleuroscopy. An adequate sample is crucial for the differential diagnosis of malignant fibrothorax (malignant pleural mesothelioma, metastatic lung carcinoma, etc.) from benign fibrothorax (benign asbestos pleural disease, tuberculous pleuritis, etc.). Novel biopsy techniques are required in flex-rigid pleuroscopy to improve the sample size and quality. The SB knife Jr, which is a scissor forceps that uses a mono-pole high frequency, was developed to allow convenient and accurate resection of larger lesions during endoscopic dissection (ESD). Herein, we report two patients with fibrothorax who underwent a pleural biopsy using an SB knife Jr to investigate the potential use of this tool in flex-rigid pleuroscopy when pleural lesions are difficult to biopsy via SFF. The biopsies were successful, with sufficient size and quality for definitive diagnosis. We also successfully performed adhesiolysis with the SB knife Jr in one case, and adequate biopsies were conducted. No complications were observed. Electrosurgical biopsy with the SB knife Jr during flex-rigid pleuroscopy allowed us to obtain adequate samples for the diagnosis of malignant versus benign fibrothorax, which is usually not possible with SFF. The SB knife Jr also demonstrated a potential use for pleuropulmonary adhesions.

In plain English

This case report described two patients with fibrothorax (thickened, fibrous pleura) whose pleura were biopsied with the SB knife Jr during flex-rigid pleuroscopy. The SB knife Jr is a scissor-type electrosurgical knife first developed for endoscopic dissection. The first patient, a 46-year-old Chinese man, had a right pleural effusion. Sampling with standard flexible forceps failed because the thickened pleura was firm and smooth. The SB knife Jr cut the pleura, and a cryoprobe collected a piece measuring 8 mm by 10 mm; the whole operation took about 10 minutes without bleeding or chest pain. The biopsy showed metastatic lung adenocarcinoma. In the second patient, a 51-year-old Chinese man, the SB knife Jr was first used to cut pleural adhesions. The knife then cut the pleura, and a cryoprobe collected a 13 mm by 9 mm piece without bleeding or chest pain. The biopsy showed chronic granuloma with lymphocyte infiltration, suggesting tubercular pleurisy. Neither diagnosis was mesothelioma or asbestos-related disease. The authors noted that two cases only show feasibility. They concluded that the technique gave adequate samples that standard forceps could not.

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 of two patients (feasibility report of a biopsy technique)
• Who was studied: Two Chinese men with fibrothorax and pleural effusion admitted to the First Hospital of China Medical University, Shenyang: a 46-year-old (March 2016) and a 51-year-old (April 2016)
• Exposure: No asbestos exposure was reported for either patient. The study looked at pleural biopsy with the SB knife Jr, a scissor-type monopolar electrosurgical knife, during flex-rigid pleuroscopy, after standard flexible forceps could not sample the thickened pleura
• Main results:
  • Case 1: sampling with standard flexible forceps failed because of the consistency and smooth surface of the thickened pleura
  • Case 1: the SB knife Jr was used to cut and dissect the target pleura
  • Case 1: the incised pleura was collected with a cryoprobe and measured 8 mm by 10 mm
  • Case 1: the total operation time was approximately 10 minutes, without bleeding or chest pain
  • Case 1: the biopsy showed metastatic lung adenocarcinoma
  • Case 2: the SB knife Jr was used to cut adhesions between the parietal and visceral pleura and expose the parietal pleura
  • Case 2: the pleura incised with the SB knife Jr measured 13 mm by 9 mm and was collected with a cryoprobe without pleural bleeding or chest pain; the procedure took about 20 minutes
  • Case 2: the pathological diagnosis was chronic granuloma with infiltration of lymphocytes, which suggested tubercular pleurisy
• The authors' conclusion: The authors concluded that electrocautery biopsy with the SB knife Jr during flex-rigid pleuroscopy allowed them to obtain adequate samples of malignant or benign fibrothorax, which was not possible with standard flexible forceps. They also concluded that the knife showed potential use for pleuropulmonary adhesions
• Limitations the authors state:
  • The report includes only two cases and only demonstrates feasibility of the technique
  • Not all pleural adhesions in case 2 were treated, and the effect of treatment was not followed up

Topics

Medical terms in this study, explained in our Lexicon: Biopsy, Pleural Effusion, Differential Diagnosis, Pleural Mesothelioma, Carcinoma, Asbestos-Related Pleural Disease, Pleural Biopsy.

Related studies

• 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)
• Pleuroscopic punch biopsy using insulated-tip diathermic knife-2 for the diagnosis of desmoplastic malignant mesothelioma — K. Masai, S. Sasada, et al. (2013)
• Cryobiopsy during flex-rigid pleuroscopy: an emerging alternative biopsy method in malignant pleural mesothelioma. A comparative study of pathology — T. Nakai, Y. Matsumoto, et al. (2019)
• Flex-rigid pleuroscopy under local anesthesia in patients with dry pleural dissemination on radiography — Y. Watanabe, S. Sasada, et al. (2014)
• Interpretation of pleural biopsy specimens and aspirates with the immunoperoxidase technique — A. Herbert, P.J. Gallagher (1982)
• Minimally invasive, ionizing-free, and ultrasound-guided technique to biopsy anterior mediastinal masses: first 60 cases — B. Lorenzati, R. Cristofori, et al. (2018)

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