Usefulness of new flex-rigid pleuroscopy in the diagnosis of malignant pleural mesothelioma

Our plain-English summary of Usefulness of new flex-rigid pleuroscopy in the diagnosis of malignant pleural mesothelioma, by S. Ishii, Y. Ishii, T. Kaburagi, et al (BMJ Case Reports, 2019).

The study

• Authors: S. Ishii, Y. Ishii, T. Kaburagi, T. Nakano
• Journal: BMJ Case Reports
• Published: 2019;12(1)
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This brief case report described one 83-year-old woman with shortness of breath. Scans showed fluid around the right lung and a chest nodule with a maximum standardised uptake value of 10.5 on PET. Testing of cells in the fluid did not find cancer. Doctors examined the chest lining under local anaesthesia with a new pleuroscope, the LTF-Y0032, which bends up to 180 degrees. Conventional fibrescopes (LTF-240 and LTF-260) bend up to 160 degrees, and less once biopsy forceps are inserted. The new instrument reached a mass near its entry point and took enough tissue for immunohistochemistry. Pathological examination showed malignant pleural mesothelioma of the biphasic type. Samples from small bumps elsewhere contained cancer cells but were too small for immunostaining. The article did not mention asbestos exposure. All four authors were involved in developing the device. The authors concluded that the new pleuroscope promises to increase diagnostic yield under local anaesthesia for pleural fluid of unknown origin; this one case did not measure yield. They said it remains to be evaluated whether conventional biopsy forceps or cryobiopsy gives a higher diagnostic yield for malignant pleural mesothelioma.

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 (BMJ Case Reports 'Images in…' format) describing the first diagnostic use of a new flex-rigid pleuroscope
• Who was studied: One 83-year-old woman with shortness of breath (dyspnoea). The article does not state when or at which hospital she was treated.
• Exposure: Not reported. The article does not describe any asbestos or other occupational or environmental exposure history. It is about a diagnostic instrument.
• Main results:
  • Before pleuroscopy, CT showed a right pleural effusion and a nodule at the front of the chest. FDG-PET showed a maximum standardised uptake value of 10.5 in the nodule.
  • Cytology of the pleural fluid was negative.
  • Pleuroscopy with the new LTF-Y0032 instrument showed the mass near the pleuroscope's insertion site.
  • Pathological evaluation of the biopsy showed malignant pleural mesothelioma of the biphasic type.
  • Biopsies from small protuberances at other sites also contained malignant cells, but the amount was insufficient for immunostaining.
  • The new pleuroscope bends up to 180 degrees. Conventional fibrescopes (LTF-240 and LTF-260) bend up to 160 degrees, and less once biopsy forceps are inserted.
  • The LTF-Y0032 has an internal diameter of 3.0 mm, compared with 2.8 mm for the existing pleuroscope. It allows use of 1.9 and 2.4 mm cryoprobes.
• The authors' conclusion: The authors concluded that use of the new pleuroscope promises to increase diagnostic yield under local anaesthesia for pleural effusion of unknown origin. This is a prediction; the single case did not measure yield.
• Limitations the authors state:
  • It is not yet clear whether conventional biopsy forceps or cryobiopsy give a higher diagnostic yield for malignant pleural mesothelioma. The authors said this needs future evaluation.
  • A cryoprobe is stiffer than biopsy forceps, so the full 180-degree range is difficult to reach when using one.

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: Pleural Mesothelioma.

Related studies

• Flex-rigid pleuroscopy under local anesthesia in patients with dry pleural dissemination on radiography — Y. Watanabe, S. Sasada, et al. (2014)
• 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)
• 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)
• 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)
• Evaluation of the efficacy and safety of a new flex-rigid pleuroscope — S. Ishii, H. Watanabe, et al. (2021)

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