The usefulness of full-thickness biopsy during semi-rigid pleuroscopy for differentiating between malignant pleural mesothelioma and non-specific pleurisy

Our plain-English summary of The usefulness of full-thickness biopsy during semi-rigid pleuroscopy for differentiating between malignant pleural mesothelioma and non-specific pleurisy, by T. Ueda, T. Nakai, S. Tanaka, et al (BMC Pulmonary Medicine, 2025).

The study

• Authors: T. Ueda, T. Nakai, S. Tanaka, H. Nagamine, A. Miyamoto, M. Nishimura, Y. Matsumoto, K. Sato, K. Yamada, T. Watanabe, K. Asai, Y. Matsumoto, Y. Mikami, T. Kawaguchi
• Journal: BMC Pulmonary Medicine
• Published: 2025;25(1):553
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma is a rare disease with a poor prognosis; distinguishing it from non-specific pleurisy is essential for determining an appropriate treatment strategy. We aimed to evaluate the diagnostic utility and safety of full-thickness biopsy performed during semi-rigid pleuroscopy under local anaesthesia to differentiate between malignant pleural mesothelioma and non-specific pleurisy.

Methods: Consecutive patients who attempted full-thickness biopsy using a cryoprobe or an insulated-tip diathermic knife during semi-rigid pleuroscopy between April 2019 and October 2023 were retrospectively enrolled. The diagnostic utility of full-thickness biopsy for distinguishing malignant pleural mesothelioma from non-specific pleurisy was assessed based on diagnostic accuracy, specimen quality, and procedural safety.

Results: Among the 64 patients who underwent full-thickness biopsy, 28 diagnosed with malignant pleural mesothelioma or non-specific pleurisy were included in this study. With the exception of one malignant pleural mesothelioma case diagnosed by surgical biopsy, 13 malignant pleural mesothelioma and 14 non-specific pleurisy cases were histologically diagnosed through full-thickness biopsy, with clinical courses supporting these diagnoses. The median full-thickness biopsy specimen size was 18.8 mm² (range: 0.6-364.2 mm2), and in 25 cases (89.3%), full-thickness pleura was pathologically confirmed. Full-thickness biopsy demonstrated a sensitivity of 92.9%, specificity of 100%, positive predictive value of 100%, negative predictive value of 93.3%, and an overall diagnostic accuracy of 96.4%. No severe complications were reported with the procedures.

Conclusion: Full-thickness biopsy during semi-rigid pleuroscopy provides high diagnostic accuracy and safety for differentiating malignant pleural mesothelioma from non-specific pleurisy, while yielding high-quality pleural tissue specimens.

© 2025. The Author(s).

In plain English

This was a retrospective study from Osaka Metropolitan University Hospital in Japan. It looked at patients who had a full-thickness biopsy during semi-rigid pleuroscopy, a camera examination of the chest lining done under local anaesthesia, between April 2019 and October 2023. The biopsy used a freezing probe, an insulated-tip electric knife, or both, and aimed to take all layers of the pleura. Of 64 patients biopsied this way, 28 were finally diagnosed with malignant pleural mesothelioma (14) or non-specific pleurisy (14) and were analysed. Seventeen of the 28 had asbestos exposure. The biopsy identified 13 of 14 mesotheliomas and all 14 pleurisy cases: sensitivity 92.9%, specificity 100%, accuracy 96.4%. The missed case, a biphasic mesothelioma, was diagnosed by surgical biopsy. Full-thickness tissue was confirmed in 25 cases (89.3%). Two mesothelioma patients had a prolonged air leak, and no severe complications were seen. The authors concluded the technique should be considered valuable. They cautioned that the small number of cases may overstate its usefulness and that some pleurisy cases might have been benign asbestos pleurisy.

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: Retrospective single-hospital study of diagnostic accuracy, using registry data collected prospectively
• Who was studied: Patients at Osaka Metropolitan University Hospital, Japan, April 2019 to October 2023. Of 117 who had semi-rigid pleuroscopy, 64 had a full-thickness biopsy. The 36 with other diagnoses were excluded (25 lung cancer metastasis, six non-lung cancer metastasis, three empyema, two tuberculous pleurisy). That left 28 patients: 14 with malignant pleural mesothelioma (7 epithelioid, 4 sarcomatous, 3 biphasic) and 14 with non-specific pleurisy (11 reactive mesothelial hyperplasia, 3 fibrous pleuritis). Median age was 77, and 85.7% were male.
• Exposure: The study did not examine asbestos exposure itself. A history of asbestos exposure was one of the criteria for suspecting mesothelioma. 17 of the 28 patients (60.7%) had asbestos exposure, and pleural plaques were seen on CT in 6 (21.4%). No fiber types, jobs or doses are given. What the study tested was the biopsy technique: a cryoprobe in 10 patients, an insulated-tip diathermic knife in 13, and both in 5.
• Main results:
  • Among the 28 patients with mesothelioma or non-specific pleurisy, the biopsy gave sensitivity 92.9%, specificity 100%, positive predictive value 100%, negative predictive value 93.3% and diagnostic accuracy 96.4%. It classed 13 of 14 mesotheliomas correctly and all 14 non-specific pleurisy cases correctly.
  • One biphasic mesothelioma was not diagnosed by the biopsy and was diagnosed later through surgical biopsy.
  • In one mesothelioma case (7.1% of the 14), the subtype was wrong: epithelioid on the biopsy, revised to biphasic on surgical specimens.
  • Full-thickness pleural tissue was confirmed by the pathologist in 25 of the 28 cases (89.3%). The median specimen size was 18.8 square millimetres, with a range of 0.6 to 364.2.
  • Two patients (7.1%), both with mesothelioma, had a prolonged air leak. No severe or life-threatening complications such as bleeding were observed.
  • In the non-specific pleurisy group, median follow-up was 849 days (range 121 to 1760). No recurrence of pleural effusion or malignancy was seen. Two of these patients died within one year of causes the authors reported as unrelated to mesothelioma (aspiration pneumonia and heart failure).
  • Across all 64 biopsied patients, including those with other diagnoses, the diagnostic yield was 95.3%.
• The authors' conclusion: The authors concluded that this biopsy gives high-quality tissue that includes deep pleural layers. They said it should be considered a valuable technique for telling malignant pleural mesothelioma apart from non-specific pleurisy in unexplained exudative effusion, and described it as safe and effective.
• Limitations the authors state:
  • The study did not compare this biopsy with conventional forceps biopsy during semi-rigid pleuroscopy or with rigid forceps biopsy during medical thoracoscopy.
  • Cases diagnosed as benign asbestos pleurisy were not included, and some non-specific pleurisy cases might actually have been benign asbestos pleurisy.
  • The small number of cases may have led to an overestimate of how useful the biopsy is.
  • FISH testing was not routinely done to distinguish mesothelioma from non-specific pleurisy.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Biopsy, Pleural Mesothelioma, Pleurisy, Prognosis, Pleura.

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)
• Diagnostic Utility of Pleural Fluid Cell Block versus Pleural Biopsy Collected by Flex-Rigid Pleuroscopy for Malignant Pleural Disease: A Single Center Retrospective Analysis — S. Miyoshi, S. Sasada, et al. (2016)
• Usefulness of new flex-rigid pleuroscopy in the diagnosis of malignant pleural mesothelioma — S. Ishii, Y. Ishii, et al. (2019)
• 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)
• Flex-rigid pleuroscopy under local anesthesia in patients with dry pleural dissemination on radiography — Y. Watanabe, S. Sasada, et al. (2014)
• What is the significance of non-specific pleuritis? A trick question — J. Janssen, F. Maldonado, et al. (2018)

Browse more research in BMC Pulmonary Medicine, or return to medical research.