Convex-probe endobronchial ultrasound-guided cryobiopsy for pleural tumors: three case reports

Our plain-English summary of Convex-probe endobronchial ultrasound-guided cryobiopsy for pleural tumors: three case reports, by T. Nakai, Y. Furukawa, H. Nagamine, et al (Translational Lung Cancer Research, 2026).

The study

• Authors: T. Nakai, Y. Furukawa, H. Nagamine, S. Kakuno, K. Ogawa, Y. Matsumoto, K. Yamada, T. Watanabe, K. Asai, T. Kimura, T. Okuno, T. Kawaguchi
• Journal: Translational Lung Cancer Research
• Published: 2026;15(2):43
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Endobronchial ultrasound-guided cryobiopsy (EBUS-cryo) is an emerging minimally invasive technique that enables acquisition of high-quality tissue specimens, particularly from mediastinal lymphadenopathy. Here, we describe three cases in which its application to pleural tumors helped establish a definitive diagnosis.

Case Description: Case 1 involved a 74-year-old man with multiple pleural lesions detected via computed tomography (CT), the largest of which was encased by major vessels. EBUS-cryo sampling of the largest lesion, performed through the left lower bronchus, led to the diagnosis of epithelioid pleural mesothelioma. Case 2 involved a 69-year-old man with multiple pleural masses encircling the mediastinal aspect of the right lung without associated pleural effusion. EBUS-cryo sampling of a pleural lesion located along the right dorsal side of the trachea led to the diagnosis of biphasic pleural mesothelioma. Case 3 involved an 82-year-old man with multiple pleural lesions and consolidation in the left upper lobe. Semi-rigid pleuroscopy could not establish a definitive diagnosis; however, EBUS-cryo performed on a mediastinal pleural tumor through the left posterior trachea established a diagnosis of B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) type.

Conclusions: EBUS-guided cryobiopsy of pleural tumors may represent a generally safe minimally invasive option for obtaining diagnostic tissue in selected patients.

© AME Publishing Company.

In plain English

This report described three patients at Osaka Metropolitan University Hospital, Japan, with tumors of the pleura (the lining around the lungs). Doctors took frozen tissue samples (cryobiopsy) through the airway wall under ultrasound guidance. Needle samples taken first were hard to diagnose from because of blood contamination, damage or too little tissue. In a 74-year-old man with 5 years of occupational asbestos exposure in construction work, the cryobiopsy samples led to a diagnosis of epithelioid pleural mesothelioma. In a 69-year-old man with no asbestos exposure, they showed biphasic pleural mesothelioma. In an 82-year-old man who reported asbestos exposure, an earlier pleuroscopy showed only inflammation. Cryobiopsy then showed a B-cell lymphoma, most consistent with MALT lymphoma, which the authors inferred had spread to the pleura from the lung. Two patients had minor bleeding controlled by suction. The authors concluded the method may be a generally safe, minimally invasive option for selected patients. They noted that three cases is a small number and that there was no direct comparison with other biopsy methods. The report did not examine what caused these diseases.

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 (three cases)
• Who was studied: Three men, aged 74, 69 and 82, with pleural tumors, evaluated at Osaka Metropolitan University Hospital, Japan
• Exposure: The study examined a biopsy technique, not asbestos. Asbestos histories were reported: Case 1 had occupational asbestos exposure during construction work for 5 years. Case 2 had no asbestos exposure. Case 3 reported a history of asbestos exposure (no details given). No fiber types were named.
• Main results:
  • Case 1 (74-year-old man): needle (EBUS-TBNA) specimens suggested malignancy, but a definitive diagnosis was difficult because of blood contamination, artifacts and limited specimen volume.
  • Case 1: the cryobiopsy specimens led to a diagnosis of epithelioid pleural mesothelioma, and chemotherapy was started.
  • Case 1: minor bleeding occurred and was controlled by suction, with no additional complications.
  • Case 2 (69-year-old man, no asbestos exposure): the cryobiopsy specimens established biphasic pleural mesothelioma. No severe adverse events were observed.
  • Case 3 (82-year-old man): an earlier semi-rigid pleuroscopy biopsy showed only inflammatory changes and gave no definitive diagnosis.
  • Case 3: the cryobiopsy specimens supported B-cell malignant lymphoma, most consistent with MALT lymphoma.
  • Case 3: the authors inferred that the lymphoma began in the left upper lobe of the lung and had spread into the pleura.
  • Cryobiopsy specimen size across the present cases: median area 5.48 square millimetres (range 4.28 to 9.22); mean area 6.13 square millimetres, standard deviation 1.70.
• The authors' conclusion: The authors concluded that ultrasound-guided cryobiopsy of pleural tumors may be a generally safe, minimally invasive option for obtaining diagnostic tissue in selected patients.
• Limitations the authors state:
  • The sample was small (three cases), and the technique was not directly compared with conventional biopsy techniques.
  • Only a 25-gauge needle was used, so feasibility with other needle sizes has not been verified.
  • Two tests that support a mesothelioma diagnosis (MTAP immunohistochemistry and CDKN2A FISH) were not performed.

Topics

Medical terms in this study, explained in our Lexicon: Ultrasound, Lymphadenopathy, Bronchus, Epithelioid, Pleural Mesothelioma, Pleural Effusion, Biphasic Mesothelioma, Consolidation.

Related studies

• The role of endobronchial ultrasound guided transbronchial needle aspiration cytology in the investigation of mediastinal lymphadenopathy and masses, the North Tees experience — S. Natu, J. Hoffman, et al. (2010)
• "Dry" pleural mesothelioma successfully diagnosed on endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) — F. Lococo, G. Rossi, et al. (2014)
• Endobronchial ultrasound-guided transbronchial needle aspiration with the flexible 19-gauge needle — R. Trisolini, F. Natali, et al. (2018)
• Endobronchial ultrasound-guided transbronchial needle aspiration in a patient with pericardial mesothelioma — H. Ashinuma, M. Shingyoji, et al. (2015)
• Diagnostic usefulness of endobronchial ultrasound-guided transbronchial needle aspiration in a case with malignant pleural mesothelioma — J. Hamamoto, D. Notsute, et al. (2010)
• The role of endobronchial ultrasound-guided fine needle aspiration in the diagnosis of pleural mesothelioma — M.R. Ghigna, A. Crutu, et al. (2016)

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