Pleuroscopic punch biopsy using insulated-tip diathermic knife-2 for the diagnosis of desmoplastic malignant mesothelioma

Our plain-English summary of Pleuroscopic punch biopsy using insulated-tip diathermic knife-2 for the diagnosis of desmoplastic malignant mesothelioma, by K. Masai, S. Sasada, T. Izumo, et al (Journal of Bronchology & Interventional Pulmonology, 2013).

The study

• Authors: K. Masai, S. Sasada, T. Izumo, T. Taniyama, Y. Nakamura, C. Chavez, H. Sakurai, K. Tsuta, T. Tsuchida
• Journal: Journal of Bronchology & Interventional Pulmonology
• Published: 2013;20(4):345-8
• Type of article: Case report, Review
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Desmoplastic malignant mesothelioma (DMM) is a rare subtype of malignant pleural mesothelioma (MPM) and is often difficult to distinguish from pleural fibrosis and reactive mesothelial hyperplasia, especially if the biopsy samples are small. We performed full-thickness pleural biopsy on a lesion suspected to be DMM using an insulated-tip diathermic knife-2 (IT knife-2) during flex-rigid pleuroscopy. IT knife-2 is a novel electrosurgical device for endoscopic submucosal dissection in the early gastrointestinal cancer. It consists of a needle knife with 3 short blades at the distal end attached to an insulated ceramic tip. A 54-year-old man presenting with chest wall mass and thickened pleura, in whom a computed tomography-guided percutaneous needle aspiration had remained negative, underwent flex-rigid pleuroscopy for definitive diagnosis. While applying electric current, we used the IT knife-2 to incise the pleura in a circular shape just above the endothoracic fascia. The incised pleura was removed by forceps and examined pathologically. The microscopic examination was compatible with DMM. We discovered that pleuroscopic punch biopsy using IT knife-2 can diagnose DMM. Use of IT knife-2 during flex-rigid pleuroscopy can obtain sufficient samples from densely thickened pleura, which is difficult to diagnose with small biopsies.

In plain English

This brief case report from Tokyo, Japan, described one patient. He was a 54-year-old man with cough and chest pain who had been exposed to asbestos while working in building maintenance. The fiber type was not reported. CT showed a mass in the right chest wall and thickened pleura, and an earlier CT-guided needle biopsy had been inconclusive. The authors examined the chest cavity with a pleuroscope under local anesthesia. The pleura was quite difficult to grasp with standard forceps, so the authors used the IT knife-2, an electrosurgical tool made for gastrointestinal endoscopy, to cut out a round, full-thickness piece of pleura. The microscope and staining findings were consistent with desmoplastic malignant mesothelioma, a rare subtype of malignant pleural mesothelioma. The authors noted it can be hard to tell apart from chronic fibrous pleuritis in small samples. The procedure took about one hour. Mild bleeding and chest pain were the only complications, and the patient was discharged the next day. The authors concluded the technique is feasible for diagnosing this tumor, adding that further experience is needed before widespread use.

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 (brief report of one patient, with a short discussion of the literature)
• Who was studied: one 54-year-old man with cough and chest pain, examined by doctors at the National Cancer Center Hospital, Tokyo, Japan; dates not given
• Exposure: occupational asbestos exposure in prior building maintenance work; fiber type and amount not reported
• Main results:
  • An earlier CT-guided needle biopsy at another hospital was inconclusive
  • The chest wall mass itself could not be reached because adhesions from the right middle lobe covered it, and the thickened pleura was quite difficult to grasp with standard flexible forceps because of its consistency and smooth surface
  • The specimen taken with the IT knife-2 kept the full-thickness structure of the pleura
  • The tissue showed atypical spindle cells, a prominent storiform collagen pattern and lack of zonation, and stained positive for pan-keratin (AE1/3), calretinin and Wilms tumor-1; the findings were consistent with desmoplastic malignant mesothelioma
  • The operation took about 1 hour; mild pleural bleeding and chest pain were the only complications
  • The patient was discharged the day after the procedure
• The authors' conclusion: The authors concluded that pleuroscopic punch biopsy using the IT knife-2 is a feasible technique for diagnosing desmoplastic malignant mesothelioma and can obtain sufficient samples from densely thickened pleura
• Limitations the authors state:
  • The authors stated that further experience is required before the technique is widely used

Topics

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

Medical terms in this study, explained in our Lexicon: Biopsy, Desmoplastic Mesothelioma, Malignant Mesothelioma, Pleural Mesothelioma, Fibrosis, Reactive Mesothelial Hyperplasia, Pleural Biopsy, Pleura.

Related studies

• An electrocautery pleural biopsy for the diagnosis of desmoplastic malignant mesothelioma during semirigid thoracoscopy — S. Sasada, K. Kawahara, et al. (2008)
• 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)
• Flex-rigid pleuroscopic biopsy with the SB knife Jr is a novel technique for diagnosis of malignant or benign fibrothorax — X.B. Wang, Y. Yin, et al. (2016)
• 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)
• Physician-based ultrasound-guided biopsy for diagnosing pleural disease — R.J. Hallifax, J.P. Corcoran, et al. (2014)
• Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma — M. Sperandeo, L. Dimitri, et al. (2014)

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