Diagnostic Utility of Pleural Fluid Cell Block versus Pleural Biopsy Collected by Flex-Rigid Pleuroscopy for Malignant Pleural Disease: A Single Center Retrospective Analysis

Our plain-English summary of Diagnostic Utility of Pleural Fluid Cell Block versus Pleural Biopsy Collected by Flex-Rigid Pleuroscopy for Malignant Pleural Disease: A Single Center Retrospective Analysis, by S. Miyoshi, S. Sasada, T. Izumo, et al (PloS One, 2016).

The study

• Authors: S. Miyoshi, S. Sasada, T. Izumo, Y. Matsumoto, T. Tsuchida
• Journal: PloS One
• Published: 2016;11(11):e0167186
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Some trials recently demonstrated the benefit of targeted treatment for malignant disease; therefore, adequate tissues are needed to detect the targeted gene. Pleural biopsy using flex-rigid pleuroscopy and pleural effusion cell block analysis are both useful for diagnosis of malignancy and obtaining adequate samples. The purpose of our study was to compare the diagnostic utility between the two methods among patients with malignant pleural disease with effusion.

Methods: Data from patients who underwent flex-rigid pleuroscopy for diagnosis of pleural effusion suspicious for malignancy at the National Cancer Center Hospital, Japan between April 2011 and June 2014 were retrospectively reviewed. All procedures were performed under local anesthesia. At least 150 mL of pleural fluid was collected by pleuroscopy, followed by pleural biopsies from the abnormal site.

Results: Thirty-five patients who were finally diagnosed as malignant pleural disease were included in this study. Final diagnoses of malignancy were 24 adenocarcinoma, 1 combined adeno-small cell carcinoma, and 7 malignant pleural mesothelioma (MPM), and 3 metastatic breast cancer. The diagnostic yield was significantly higher by pleural biopsy than by cell block [94.2% (33/35) vs. 71.4% (25/35); p = 0.008]. All patients with positive results on cell block also had positive results on pleural biopsy. Eight patients with negative results on cell block had positive results on pleural biopsy (lung adenocarcinoma in 4, sarcomatoid MPM in 3, and metastatic breast cancer in 1). Two patients with negative results on both cell block and pleural biopsy were diagnosed was sarcomatoid MPM by computed tomography-guided needle biopsy and epithelioid MPM by autopsy.

Conclusion: Pleural biopsy using flex-rigid pleuroscopy was efficient in the diagnosis of malignant pleural diseases. Flex-rigid pleuroscopy with pleural biopsy and pleural effusion cell block analysis should be considered as the initial diagnostic approach for malignant pleural diseases presenting with effusion.

In plain English

This retrospective study from one Japanese cancer hospital compared two ways of diagnosing cancer that causes fluid around the lungs (pleural effusion). It reviewed 35 patients who had flex-rigid pleuroscopy under local anesthesia between April 2011 and June 2014 and were finally diagnosed with malignant pleural disease: 24 adenocarcinoma, 1 combined adeno-small cell carcinoma, 7 malignant pleural mesothelioma and 3 metastatic breast cancer. Five patients (14.3%) had a prior history of asbestos exposure. During the procedure, at least 150 mL of fluid was collected for a cell block, and tissue biopsies were then taken from the pleura. Biopsy gave a diagnosis in 94.2% (33/35) of patients and cell block in 71.4% (25/35), a statistically significant difference. Among the 7 mesothelioma patients, cell block was positive in 2 and biopsy in 5, a difference that was not statistically significant. All sarcomatoid mesotheliomas were negative on cell block. One patient had a prolonged pneumothorax that improved with longer drainage. The authors concluded that biopsy plus cell block should be considered as the initial approach. They noted the single-center setting and small sample.

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: Single-center retrospective study comparing the diagnostic yield of pleural fluid cell block and pleural biopsy taken during the same flex-rigid pleuroscopy
• Who was studied: 68 patients had flex-rigid pleuroscopy at the National Cancer Center Hospital, Japan, between April 2011 and June 2014. A cell block was prepared in 39 of them. The 35 finally diagnosed with malignant pleural disease were included: 24 adenocarcinoma, 1 combined adeno-small cell carcinoma, 7 malignant pleural mesothelioma (2 epithelioid, 4 sarcomatoid, 1 biphasic) and 3 metastatic breast cancer.
• Exposure: The study compared two diagnostic samples; it was not a study of asbestos exposure. Five of the 35 patients (14.3%) had a prior history of asbestos exposure. No fiber types, products, jobs or doses were reported.
• Main results:
  • All 35 patients: pleural biopsy gave a diagnosis in 94.2% (33/35) and cell block in 71.4% (25/35); p = 0.008
  • Every patient with a positive cell block also had a positive pleural biopsy
  • Of the 10 patients with a negative cell block, 8 had a positive pleural biopsy: lung adenocarcinoma in 4, sarcomatoid mesothelioma in 3 and metastatic breast cancer in 1
  • Malignant pleural mesothelioma patients (7): cell block positive in 2/7 (28.6%) and pleural biopsy positive in 5/7 (71.4%); p = 0.250, not statistically significant
  • Lung adenocarcinoma patients (24): cell block positive in 20/24 (83.3%) and pleural biopsy positive in 24/24 (100%); p = 0.125, not statistically significant
  • All patients with sarcomatoid mesothelioma had negative cell block results
  • Two patients were negative on both cell block and pleural biopsy. One was later diagnosed with sarcomatoid mesothelioma by CT-guided needle biopsy and the other with epithelioid mesothelioma at autopsy.
  • Cell block was non-diagnostic in 5 of the 10 patients with pleural loculations and in 5 of the 25 patients without them. The authors described this as a tendency; no p value was given.
  • One patient developed a prolonged pneumothorax, which improved with prolonged chest-tube drainage
• The authors' conclusion: The authors concluded that pleural biopsy using flex-rigid pleuroscopy was efficient in diagnosing malignant pleural diseases. They concluded that flex-rigid pleuroscopy with both pleural biopsy and pleural effusion cell block analysis should be considered as the initial diagnostic procedure for malignant pleural disease presenting with effusion.
• Limitations the authors state:
  • The study was performed at a single cancer center, with possible bias in patient selection
  • It was a retrospective analysis of a small sample that included only patients finally diagnosed with malignancy; the authors stated that a randomized multi-center trial is needed

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: Cell Block, Pleural Biopsy, Pleural Effusion, Adenocarcinoma, Carcinoma, Pleural Mesothelioma, Lung Adenocarcinoma, Sarcomatoid.

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)
• Flex-rigid pleuroscopy under local anesthesia in patients with dry pleural dissemination on radiography — Y. Watanabe, S. Sasada, et al. (2014)
• Usefulness of new flex-rigid pleuroscopy in the diagnosis of malignant pleural mesothelioma — S. Ishii, Y. Ishii, et al. (2019)
• The usefulness of full-thickness biopsy during semi-rigid pleuroscopy for differentiating between malignant pleural mesothelioma and non-specific pleurisy — T. Ueda, T. Nakai, et al. (2025)
• Semi-Rigid Thoracoscopic Punch Biopsy Using a Hybrid Knife with a High-Pressure Water Jet for the Diagnosis of Pleural Effusions — Y. Yin, R. Eberhardt, et al. (2016)
• Rigid Mini-Thoracoscopy: The New Kid on the Block — E.O. Bedawi, N.M. Rahman (2020)

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