Use of cryobiopsy during pleuroscopy for diagnosis of sarcomatoid malignant mesothelioma

Our plain-English summary of Use of cryobiopsy during pleuroscopy for diagnosis of sarcomatoid malignant mesothelioma, by H.P. Chan, M.F. Liew, J.E. Seet, et al (Thorax, 2017).

The study

• Authors: H.P. Chan, M.F. Liew, J.E. Seet, P. Lee
• Journal: Thorax
• Published: 2017;72(2):193-195
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

Authors from the National University Health System, Singapore, reported the case of a 74-year-old man who presented with a cough of 3 weeks' duration. A chest X-ray showed a large left-sided pleural effusion. The fluid was a lymphocytic exudate with a normal adenosine deaminase level and negative bacterial and mycobacterial cultures. Flex-rigid pleuroscopy showed candle-wax fibrotic parietal pleura. This was sampled with flexible forceps (cusps 2.4 mm when fully open) and with a 2.4 mm cryoprobe using a 4-second freeze time. The pleuroscope and the cryoprobe, with the specimen frozen to its tip, were removed together through the trocar. The cryobiopsies showed sarcomatoid malignant mesothelioma. The forceps biopsies were non-diagnostic, showing fibrin and reactive fibroblasts. The cryobiopsies were larger and deeper, with better-preserved architecture. The authors noted that early or sarcomatoid mesothelioma can be hard to diagnose because the small forceps used through the pleuroscope may not obtain deep enough samples. They noted that surgical approaches have reported diagnostic accuracy of 74–100%. They summarised two earlier small studies of pleural cryobiopsy, in 22 and 15 patients, with diagnostic yields of 95.5% and 93.3%; the complications reported were mainly mild bleeding. The authors concluded that cryobiopsy is not routinely performed during pleuroscopy, but this case highlighted its potential role when smooth, fibrotic pleura is encountered.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This was a short case report, published as an "Images in Thorax" item, by doctors at a hospital system in Singapore. It described a 74-year-old man who had had a cough for 3 weeks. A chest X-ray showed a large collection of fluid around the left lung (a pleural effusion). During pleuroscopy, a procedure in which a camera is passed into the chest, the doctors saw thickened, fibrotic chest-wall lining with a "candle-wax" look. They took tissue samples in two ways: with standard flexible forceps, and with a 2.4 mm freezing probe (cryoprobe) applied for 4 seconds. The cryoprobe samples showed sarcomatoid malignant mesothelioma. The forceps samples did not give a diagnosis and showed only fibrin and reactive fibroblasts. The authors reported that the cryobiopsies were larger, deeper and better preserved. They noted that cryobiopsy is not routinely performed during pleuroscopy, and concluded that this case highlights its potential role when smooth, fibrotic pleura is encountered. The report describes one patient and does not mention asbestos exposure.

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 (single patient), published as an "Images in Thorax" item
• Who was studied: One 74-year-old man with a 3-week cough, treated at the National University Health System, Singapore (dates of care not given)
• Exposure: Not reported; the article does not mention asbestos or any other exposure. The report compares two biopsy methods during pleuroscopy: flexible forceps and a 2.4 mm cryoprobe with a 4-second freeze time.
• Main results:
  • Chest X-ray showed a large left-sided pleural effusion
  • Pleuroscopy showed candle-wax fibrotic parietal pleura
  • In this patient, the cryobiopsies showed a malignant spindle cell tumour (sarcomatoid malignant mesothelioma)
  • In this patient, the forceps biopsies were non-diagnostic and showed fibrin and reactive fibroblasts
  • In this patient, the cryobiopsies were larger, of sufficient depth and had better-preserved architecture than the forceps biopsies
• The authors' conclusion: The authors concluded that, although cryobiopsy is not routinely performed during pleuroscopy, this case highlights its potential role when smooth, fibrotic pleura is encountered.

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: Sarcomatoid, Malignant Mesothelioma, Chest X-Ray, Pleural Effusion, Exudate, Parietal Pleura, Fibroblast, Mesothelioma.

Related studies

• 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)
• 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)
• Advances in pleuroscopy — S. Anevlavis, M.E. Froudarakis (2018)
• Flex-rigid pleuroscopy under local anesthesia in patients with dry pleural dissemination on radiography — Y. Watanabe, S. Sasada, et al. (2014)
• 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)

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