Semi-Rigid Thoracoscopic Punch Biopsy Using a Hybrid Knife with a High-Pressure Water Jet for the Diagnosis of Pleural Effusions

Our plain-English summary of Semi-Rigid Thoracoscopic Punch Biopsy Using a Hybrid Knife with a High-Pressure Water Jet for the Diagnosis of Pleural Effusions, by Y. Yin, R. Eberhardt, X.B. Wang, et al (Respiration; International Review of Thoracic Diseases, 2016).

The study

• Authors: Y. Yin, R. Eberhardt, X.B. Wang, Q.Y. Wang, J. Kang, F.J. Herth, G. Hou
• Journal: Respiration; International Review of Thoracic Diseases
• Published: 2016;92(3):192-6
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Semi-rigid thoracoscopy is an important technique in the definitive diagnosis of pleural diseases with high diagnostic sensitivity and specificity. Obtaining adequate samples from thickened pleura is the most important limitation of semi-rigid thoracoscopy with a standard flexible forceps (SFF) compared with rigid thoracoscopy, especially in patients with mesothelioma or benign fibrothorax. Developing a convenient, efficient and safe biopsy technique to obtain sufficient samples from such patients is a key topic in semi-rigid thoracoscopy. The hybrid knife (HK) is an innovative design fusing high-pressure water injection and a conventional diathermic knife that can allow for the safe resection of a larger lesion during gastrointestinal endoscopic dissection. Here, we describe 3 patients with unexplained pleural effusion who underwent pleural biopsy using an HK to investigate the potential use of the HK as a new pleural biopsy device in semi-rigid thoracoscopy when pleural lesions are difficult to biopsy using an SFF. The biopsies were obtained successfully by HK, and the diagnosis followed. The sizes of the biopsies collected by HK are larger than those collected by SFF. No complications were observed. Electrocautery biopsy using an HK during semi-rigid thoracoscopy has great potential for diagnosing consistent abnormal pleuras, which are difficult to biopsy with an SFF.

© 2016 S. Karger AG, Basel.

In plain English

This was a report of 3 patients, written by doctors in Shenyang, China, and Heidelberg, Germany. They tested a surgical tool called a hybrid knife, which combines a high-pressure water jet with an electric cutting knife, for taking samples of thickened pleura (the lining around the lungs) during semi-rigid thoracoscopy. All 3 patients were seen in April 2016 with fluid around the lung (pleural effusion) of unknown cause, and their pleura was hard to sample with standard flexible forceps. Benign asbestos pleural disease is mentioned only in the introduction and in an 'Established Facts' box, as one example of thickened pleura that is hard to biopsy. None of the 3 patients was described as having asbestos exposure or mesothelioma. Samples were taken in all 3 patients. One was diagnosed with metastatic lung adenocarcinoma and two with tuberculous pleurisy. The samples measured 20 by 10 mm and 8 by 12 mm in the first two cases, and no complications were reported. The authors concluded the method is potentially feasible and convenient. They noted that 3 cases only show feasibility and that complications may increase with more cases.

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 reports (3 patients)
• Who was studied: 3 patients with unexplained pleural effusion (a 56-year-old woman, a 52-year-old man and a 29-year-old man) admitted to The First Hospital of China Medical University, Shenyang, in April 2016
• Exposure: No asbestos exposure was studied. The study concerned a biopsy device, a water jet hybrid knife (Erbe Hybrid Knife T-type I-jet), used during semi-rigid thoracoscopy. Benign asbestos pleural disease is mentioned only in the introduction and the 'Established Facts' box, as an example of thickened pleura that is hard to biopsy.
• Main results:
  • Case 1 (56-year-old woman): specimens could not be obtained with standard flexible forceps. The hybrid knife removed a piece of pleura measuring 20 × 10 mm without pleural bleeding or chest pain.
  • Case 1: the pathological diagnosis was metastatic lung adenocarcinoma
  • Case 2 (52-year-old man): the hybrid knife sample measured 8 × 12 mm, which was larger than the sample taken with standard flexible forceps. No complications were observed.
  • Case 2: chronic granuloma suggested tubercular pleurisy, and the effusion was obviously absorbed one month after anti-tuberculosis therapy
  • Case 3 (29-year-old man): the biopsy took about 7 minutes. The patient was diagnosed with tuberculosis pleurisy, and the effusion had disappeared 2 months after anti-tuberculosis therapy.
  • In the authors' experience, the hybrid knife biopsy procedure time did not exceed 15 minutes
• The authors' conclusion: The authors concluded that a hybrid knife with a water jet is a potentially feasible and convenient biopsy technique in semi-rigid thoracoscopy for diagnosing thickened pleural lesions, notably when fibrothorax or smooth, thickened lesions are encountered.
• Limitations the authors state:
  • The report contains only 3 cases and only demonstrates feasibility
  • With more cases, the number of complications may increase
  • Further study is needed on efficacy, safety and best indications

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Biopsy, Pleural Effusion, Thoracoscopy, Pleura, Mesothelioma, Pleural Biopsy.

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)
• 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)
• An electrocautery pleural biopsy for the diagnosis of desmoplastic malignant mesothelioma during semirigid thoracoscopy — S. Sasada, K. Kawahara, et al. (2008)
• 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)
• Prospective Study of the Utility of Computed Tomography Triage of Pleural Biopsy Strategies in Patients With Pleural Diseases — M. Metintas, G. Ak, et al. (2019)
• Rigid Mini-Thoracoscopy: The New Kid on the Block — E.O. Bedawi, N.M. Rahman (2020)

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