Endoscopic ultrasound-guided pleural biopsy in the hands of the pulmonologist

Our plain-English summary of Endoscopic ultrasound-guided pleural biopsy in the hands of the pulmonologist, by R. Bibi, U. Bodtger, R. Nessar, et al (Respirology Case Reports, 2020).

The study

• Authors: R. Bibi, U. Bodtger, R. Nessar, H.K. Jensen, I. Skovgaard Christiansen, P.F. Clementsen
• Journal: Respirology Case Reports
• Published: 2020;8(2):e00517
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The use of the endobronchial ultrasound (EBUS) endoscope in the oesophagus, the so-called EUS-B procedure, for the diagnosis and staging of thoracic malignancy is quickly gaining ground. Pleural lesions located close to the oesophagus can be inaccessible to transthoracic biopsy and endoscopic procedures can be the only option. We here present two cases demonstrating that EUS-B-guided fine needle aspiration (EUS-B-FNA) of pleural lesions is possible. The first case demonstrates a EUS-B-FNA with malignant mesothelioma of a pleural lesion in a 70-year-old patient. In the second case, EUS-B-FNA diagnosed a pleural metastasis from adenoid cystic adenocarcinoma in a 75-year-old-patient. In conclusion, we hereby demonstrate that EUS-B-FNA from pleural lesions is feasible and appears to be safe.

© 2020 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

In plain English

This case report described two patients whose pleura (the lining around the lungs) was sampled with a needle guided by an airway ultrasound endoscope passed down the oesophagus, a procedure called EUS-B-FNA. The first patient was a 70-year-old man with thickening of the left pleura near the oesophagus. Ten years earlier he had been treated for left-sided malignant pleural mesothelioma. Three needle passes were made, and the samples were considered diagnostic for malignant pleural mesothelioma of epithelioid type. He was referred for palliative treatment. The second patient was a 75-year-old woman with thickening of the right pleura who had earlier had adenoid cystic adenocarcinoma removed from the parotid gland region. Her samples were considered diagnostic for spread of that cancer to the pleura. The authors reported no complications in either case. They concluded that this sampling from pleural lesions is feasible and appears to be safe. The article did not discuss asbestos exposure. Two cases cannot establish success or complication rates. The one oesophageal perforation among 32 patients mentioned in the discussion came from an earlier study that used a conventional gastrointestinal endoscope (EUS-FNA).

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 (two cases) describing a biopsy technique
• Who was studied: Two patients: a 70-year-old man with left pleural thickening who had been treated ten years earlier for left-sided malignant pleural mesothelioma, and a 75-year-old woman with right pleural thickening who had previously had adenoid cystic adenocarcinoma of the left parotid region. The authors are from Danish hospitals. The article does not state where or when the patients were seen.
• Exposure: No asbestos or other fiber exposure is reported. The article concerns a procedure: EUS-B-guided fine needle aspiration under conscious sedation, using a 22 gauge needle in case 1 and three needle passes in each case.
• Main results:
  • Case 1 (70-year-old man): the pleural samples were considered diagnostic for malignant pleural mesothelioma (MPM) of epithelioid type. The cells were positive for calretinin, CK5 and D240.
  • Case 2 (75-year-old woman): the pleural samples were considered diagnostic for metastasis from adenoid cystic adenocarcinoma.
  • No complications were observed in either of the two cases.
• The authors' conclusion: The authors concluded that EUS-B-FNA of pleural lesions is feasible and appears to be safe.

Topics

Medical terms in this study, explained in our Lexicon: Ultrasound, Pleural Biopsy, Staging, Biopsy, Mesothelioma, Metastasis, Adenocarcinoma.

Related studies

• Endoscopic Ultrasound with Bronchoscope-Guided Fine Needle Aspiration for the Diagnosis of Paraesophageally Located Lung Lesions — I. Skovgaard Christiansen, J.C. Kuijvenhoven, et al. (2019)
• Endoscopic ultrasound-guided fine-needle aspiration from ascites and peritoneal nodules: A scoping review — V. Sharma, S.S. Rana, et al. (2017)
• Endoscopic ultrasound-guided fine needle aspiration of a pericardial mass — P. Somani, M. Sharma, et al. (2016)
• Isolated pancreatic metastasis from a malignant pleural mesothelioma diagnosed using endoscopic ultrasonography-guided fine needle aspiration biopsy — Y. Ishikawa-Kakiya, H. Maruyama, et al. (2022)
• Physician-based ultrasound-guided biopsy for diagnosing pleural disease — R.J. Hallifax, J.P. Corcoran, et al. (2014)
• Ultrasound-guided percutaneous needle biopsy skill for peripheral lung lesions and complications prevention — H. Zhang, Y. Guang, et al. (2020)

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