Successful Diagnostic Confirmation of Malignant Pleural Mesothelioma With Extensive Pleural Adhesions Using Pleural Cryobiopsy Under Local Anaesthesia

Our plain-English summary of Successful Diagnostic Confirmation of Malignant Pleural Mesothelioma With Extensive Pleural Adhesions Using Pleural Cryobiopsy Under Local Anaesthesia, by S. Otaki, M. Suzuki, K. Yano, et al (Respirology Case Reports, 2026).

The study

• Authors: S. Otaki, M. Suzuki, K. Yano, T. Imoto, R. Shimizu, T. Hishima, K. Nakagawa
• Journal: Respirology Case Reports
• Published: 2026;14(8):e70704
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Local anaesthesia thoracoscopy using flex-rigid thoracoscope is useful for diagnosing pleural lesions, but it is generally not indicated in cases with extensive pleural adhesions. We report a case of malignant pleural mesothelioma (MPM) with extensive pleural adhesions that was safely diagnosed using pleural cryobiopsy under local anaesthesia. A 65-year-old man with a history of asbestos exposure presented with chest pain and significant weight loss. A very small amount of pleural effusion, narrowing of the left lower intercostal spaces on chest computed tomography (CT) and negative lung sliding sign on transthoracic echocardiography (TTE) indicated significant pleural adhesions. Considering the high risk of general anaesthesia, biopsy under minimally invasive local anaesthesia was chosen. Precise localization of the lesions using positron emission tomography-CT and TTE enables making the incision over the tumour. After minimal adhesion dissection, pleural cryobiopsy was performed and a definitive diagnosis of epithelial MPM was made.

© 2026 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

In plain English

This was a case report of one patient from Japan. The patient, a 65-year-old man with a history of asbestos exposure, had chest pain and significant weight loss. The supplied text is missing most of the case description and gives no fiber type, job or amount of exposure. Scans and ultrasound suggested extensive pleural adhesions (lung lining stuck to the chest wall). Such adhesions generally rule out thoracoscopy under local anaesthesia. Stage III malignant pleural mesothelioma was suspected. The authors judged general anaesthesia high-risk owing to weight loss, decreased performance status and severe restrictive ventilatory impairment. Taking recent clinical trial results into account as well, they planned systemic therapy. Percutaneous needle biopsy (through the skin) was not possible because there was no distinct mass. Instead, guided by imaging, the doctors made the incision directly over the tumour and took frozen-tissue samples (cryobiopsy) under local anaesthesia, freezing up to 14 seconds. This gave a definitive diagnosis of epithelial malignant pleural mesothelioma. The authors concluded that this approach can be feasible in patients with severe adhesions if safe pleural access and enough tissue can be achieved. A single case does not show how often this works.

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
• Who was studied: One man, aged 65, with suspected stage III malignant pleural mesothelioma and extensive pleural adhesions, who had weight loss, decreased performance status and severe restrictive ventilatory impairment. The authors are from Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. No dates are given.
• Exposure: A history of asbestos exposure. The available text gives no fiber type, job, product, duration or dose. Most of the case description is missing from the supplied text.
• Main results:
  • In this patient, extensive pleural adhesions were indicated by a very small amount of pleural effusion, by narrowing of the left lower intercostal spaces on chest CT, and by a negative lung sliding sign on ultrasound.
  • Stage III malignant pleural mesothelioma was suspected in this patient.
  • For this patient, the authors planned systemic therapy, taking into account his poor prognostic factors together with recent clinical trial results.
  • Because general anaesthesia was considered high-risk, the doctors chose biopsy under local anaesthesia.
  • In this patient, percutaneous needle biopsy was not possible because there was no distinct mass.
  • The doctors froze the tissue for up to 14 seconds and obtained large specimens.
  • After minimal dissection of the adhesions, pleural cryobiopsy gave a definitive diagnosis of epithelial malignant pleural mesothelioma in this patient.
• The authors' conclusion: The authors concluded that thoracoscopy under local anaesthesia using cryobiopsy can be feasible for patients with severe adhesions, if safe access to the pleural space is achievable and sufficient tissue can be obtained there.

Topics

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

Related studies

• Flex-rigid pleuroscopy under local anesthesia in patients with dry pleural dissemination on radiography — Y. Watanabe, S. Sasada, et al. (2014)
• Diagnostic accuracy of sequential co-registered PET+MR in comparison to PET/CT in local thoracic staging of malignant pleural mesothelioma — K. Martini, A. Meier, et al. (2016)
• The need for pathological confirmation of the diagnosis of peritoneal malignant mesothelioma — S.J. Geyer (2011)
• A first-in-Asian phase 1 study to evaluate safety, pharmacokinetics and clinical activity of VS-6063, a focal adhesion kinase (FAK) inhibitor in Japanese patients with advanced solid tumors — T. Shimizu, K. Fukuoka, et al. (2016)
• 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)
• Use of cryobiopsy during pleuroscopy for diagnosis of sarcomatoid malignant mesothelioma — H.P. Chan, M.F. Liew, et al. (2017)

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