Shining Light on Pleural Biopsy in Mesothelioma: Is It Time to Get "Smart"?

Our plain-English summary of Shining Light on Pleural Biopsy in Mesothelioma: Is It Time to Get "Smart"?, by E.O. Bedawi, N.M. Rahman (Chest, 2019).

The study

• Authors: E.O. Bedawi, N.M. Rahman
• Journal: Chest
• Published: 2019;156(4):643-644
• Type of article: Editorial, Comment
• Read it: PubMed · Publisher

In plain English

This is an editorial, not an original study. The authors commented on a separate study by Wijmans and colleagues, published in the same issue of CHEST. That study tested confocal laser endomicroscopy (CLE), a way to see tissue under a microscope in real time during a biopsy, in people with suspected malignant pleural mesothelioma. As the editorial described it, the study took place at two centers in Amsterdam, The Netherlands, in 15 patients, with 20 procedures evaluated. No study-related adverse events were reported. In 16 biopsies from three patients who had thoracoscopy, CLE had a sensitivity of 79%, compared with 74% for ordinary white light. The two together correctly detected malignancy in 13 of 14 biopsy locations (93%). The authors pointed to several drawbacks: the small numbers, the extra time needed (the fluorescein dye took 5 to 7 minutes to reach the pleura), only moderate agreement between three blinded raters, the need for training, and equipment costs. The authors concluded that the study showed the technique to be safe and feasible, but that further studies are needed on practicality and cost-effectiveness.

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: Editorial commenting on a separate prospective study (Wijmans et al., Chest 2019;156(4):754-763); not original research
• Who was studied: In the study discussed (not this editorial): 15 patients with suspected malignant pleural mesothelioma on PET-CT imaging, at two centers in Amsterdam, The Netherlands; 20 procedures evaluated
• Exposure: Not an exposure study. The editorial discusses a biopsy technique, confocal laser endomicroscopy (CLE), used to guide pleural biopsies
• Main results:
  • In the study discussed, no study-related adverse events were reported
  • In 16 biopsies from three patients undergoing thoracoscopy, CLE sensitivity was 79% compared with 74% for white light
  • Using CLE and white light together correctly detected malignancy in 13 of 14 biopsy locations (sensitivity 93%)
  • Fluorescein took 5 to 7 minutes to reach the pleura, compared with 1 minute for intrathoracic tumors and lymph nodes
  • Only moderate agreement was found between the three blinded raters of the CLE recordings
• The authors' conclusion: The authors considered that the study showed CLE to be safe and feasible, but said further studies are needed to determine practicality and cost-effectiveness before CLE could be integrated into practice
• Limitations the authors state:
  • Small numbers in the study discussed
  • Time needed for the procedure may limit its use in pleural biopsy
  • Requires a robust training pathway in histopathology and technical aspects
  • Cost: basic equipment around $175,000 and probes $7,000 to $10,000 each

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: Pleural Biopsy, Mesothelioma.

Related studies

• Real-time light dosimetry for intra-cavity photodynamic therapy: Application for pleural mesothelioma treatment — N. Betrouni, C. Munck, et al. (2017)
• Real-time detection of airborne asbestos by light scattering from magnetically re-aligned fibers — C. Stopford, P.H. Kaye, et al. (2013)
• Flagellate pigmentation from intrapleural bleomycin. A light microscopy and electron microscopy study — A.C. Fernandez-Obregon, K.P. Hogan, et al. (1985)
• Pleural biopsy in the diagnosis of malignant mesothelioma — A. Herbert, P.J. Gallagher (1982)
• Interpretation of pleural biopsy specimens and aspirates with the immunoperoxidase technique — A. Herbert, P.J. Gallagher (1982)
• High dose irradiation after pleurectomy/decortication or biopsy for pleural mesothelioma treatment — E. Parisi, A. Romeo, et al. (2017)

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