Ultra-magnifying Imaging of Thoracoscopic Biopsy Specimens Using Ex vivo Endocytoscopy in Three Patients with Mesothelioma

Our plain-English summary of Ultra-magnifying Imaging of Thoracoscopic Biopsy Specimens Using Ex vivo Endocytoscopy in Three Patients with Mesothelioma, by Y. Shiratsuki, N. Kurimoto, Y. Amano, et al (Internal Medicine, 2022).

The study

• Authors: Y. Shiratsuki, N. Kurimoto, Y. Amano, S. Hamaguchi, M. Kobayashi, T. Okuno, T. Hotta, Y. Tsubata, T. Isobe
• Journal: Internal Medicine
• Published: 2022;61(21):3251-3257
• Read it: PubMed · Publisher · Free full text

Abstract

We performed endocytoscopy (ECS) for the ex vivo evaluation of mesothelioma in specimens biopsied during medical thoracoscopy in three patients. We evaluated 19 biopsy specimens based on the density of nuclei and irregularity in the nuclei shape using ECS and compared them with the histopathological findings. All 10 specimens considered malignant based on ECS were diagnosed as malignant based on histopathology. The nine specimens evaluated as non-malignant based on ECS consisted of six specimens diagnosed as malignant based on histopathology and three diagnosed as non-malignant based on histopathology. ECS was feasible and had some utility for ex vivo ultra-magnifying imaging of thoracoscopic biopsy specimens from patients with mesothelioma.

In plain English

This case report described three men in Japan with mesothelioma who had medical thoracoscopy, an examination of the chest cavity under local anesthesia, at Shimane University between October 2018 and March 2019. One had asbestos exposure in demolition work, one had asbestos inhalation while working at an oil company, and one had worked as a plasterer for over 50 years. The authors tested endocytoscopy, a camera that magnifies 450-fold, on pleural biopsy samples after removal from the body. They classed each sample as malignant or non-malignant by how dense and how irregularly shaped the cell nuclei looked, then compared this with standard pathology. Of 22 samples, 3 were too small for pathology, leaving 19. All 10 samples judged malignant by endocytoscopy were malignant on pathology. Of the 9 judged non-malignant, pathology found 6 malignant and 3 non-malignant. Overall sensitivity was 63%, specificity 100% and accuracy 68%. The authors concluded the method was feasible and had some utility. They noted that only three patients were studied and that there were no data on other pleural diseases. The study did not measure 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 (case series) of three patients, testing a diagnostic imaging technique (ex vivo endocytoscopy) against histopathology
• Who was studied: All three patients (men aged 89, 69 and 80) who had thoracoscopy under local anesthesia at the Division of Medical Oncology & Respiratory Medicine, Shimane University, Japan, October 2018 to March 2019. Patient 1 was diagnosed with malignant mesothelioma (type not diagnosed). Patients 2 and 3 were diagnosed with desmoplastic mesothelioma. 22 biopsy specimens were taken in total.
• Exposure: The study examined a diagnostic technique, not an exposure. As patient history only: Patient 1 had asbestos exposure in the demolition industry, Patient 2 had worked as a plasterer for over 50 years, and Patient 3 had a history of asbestos inhalation while working at an oil company. No fiber types or doses were given.
• Main results:
  • In Patient 2, three of eight biopsy specimens were too small for histopathology. This left 19 of 22 specimens for comparison.
  • Across the three patients, 10 specimens were judged malignant by endocytoscopy based on irregularly shaped nuclei, and all were malignant on histopathology.
  • Of the 9 specimens judged non-malignant by endocytoscopy, histopathology found 6 malignant and 3 non-malignant.
  • In Patient 3, five of nine specimens were judged non-malignant by endocytoscopy (low density of nuclei, regularly shaped nuclei) but were malignant on histopathology. Sensitivity for Patient 3's specimens was 44%.
  • Across all 19 compared specimens, overall sensitivity was 63%, specificity 100% and diagnostic accuracy 68%.
• The authors' conclusion: The authors concluded that this case series suggests ex vivo endocytoscopy was feasible and had some utility for ultra-magnifying imaging of thoracoscopic biopsy specimens from patients with mesothelioma.
• Limitations the authors state:
  • Endocytoscopy was performed in only three patients with mesothelioma.
  • There were no data on other pleural diseases.
  • Endocytoscopy views the surface of a specimen, while histopathology examines a cut surface at its center. The authors suggested this difference in observation sites might explain the discrepancies.
  • In specimens with a low density of nuclei, nuclear irregularity was somewhat difficult to evaluate because there were few nuclei.

Topics

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

Medical terms in this study, explained in our Lexicon: Thoracoscopy, Mesothelioma, Medical Thoracoscopy, Biopsy, Histopathology.

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