Skip to main content

Advertisement

SpringerLink
Log in

A new electrocautery pleural biopsy technique using an insulated-tip diathermic knife during semirigid pleuroscopy

  • New Technology
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The biopsy size obtained with standard flexible forceps (SFF) during semirigid pleuroscopy is often insufficient for pathological examination. An insulated-tip diathermic knife (IT knife) allows safe resection of a larger lesion during gastrointestinal endoscopy. We sought to validate an electrocautery pleural biopsy technique using the IT knife during semirigid pleuroscopy. We compared the diagnosis of specimens obtained using the IT knife and SFF in 20 subjects with unexplained pleural effusion, and reviewed pleuroscopic parameters such as complications, procedure time, and diameter of the specimens.

Methods

After injecting saline with lidocaine and epinephrine below the affected pleura, the lesion was incised in a circular shape with full thickness by manipulating the IT knife.

Results

Diagnostic yields from specimens obtained with the IT knife and SFF were 85% (17 of 20 cases) and 60% (12 of 20 cases), respectively. The IT knife biopsy was superior to SFF in 8 of 20 patients (malignant pleural mesothelioma in three, nonspecific inflammation in two, metastatic breast cancer in one, and tuberculosis in one). These pleural lesions revealed thickened, smooth abnormal appearances. The overall diagnostic yield for both IT knife and SFF was 100%. Median time of the procedure, from first pleural injection to specimen removal, was 21 min (range 12–92 min), and median diameter of specimen was 13 mm (range 6–23 mm). There were no severe complications during the procedure.

Conclusions

Electrocautery biopsy using the IT knife during semirigid pleuroscopy has great potential for diagnosing smooth abnormal pleura which are difficult to biopsy with SFF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

IT knife:

Insulated-tip diathermic knife

SFF:

Standard flexible forceps

ESD:

Endoscopic submucosal dissection

MPM:

Malignant pleural mesothelioma

DDM:

Desmoplastic malignant mesothelioma

References

  1. Poe RH, Israel RH, Utell MJ et al (1984) Sensitivity, specificity, and predictive values of closed pleural biopsy. Arch Intern Med 144:325–328

    Article  PubMed  CAS  Google Scholar 

  2. Prakash UBS, Relman H (1985) Comparison of needle biopsy with cytologic analysis for the evaluation of pleural effusion: analysis of 414 cases. Mayo Clin Proc 60:158–164

    PubMed  CAS  Google Scholar 

  3. McLean AN, Stephen RB, Lawrence GM, Andrew JP (1998) Investigation of pleural effusion: an evaluation of the new Olympus LTF semiflexible thoracofiberscope and comparison with abram’s needle knife. Chest 114:150–153

    Article  PubMed  CAS  Google Scholar 

  4. Boutin C, Viallat JR, Cargnino P, Farisse P (1981) Thoracoscopy in malignant pleural effusions. Am Rev Respir Dis 124:588–592

    PubMed  CAS  Google Scholar 

  5. Canto A, Blasco E, Casillas M et al (1977) Thoracoscopy in the diagnosis of pleural effusion. Thorax 32:550–554

    Article  PubMed  CAS  Google Scholar 

  6. Weissberg D, Kaufmann M (1980) Diagnostic and therapeutic pleuroscopy. Experience with 27 patients. Chest 78:732–735

    Article  PubMed  CAS  Google Scholar 

  7. Senno A, Moallem S, Quijano ER et al (1974) Thoracoscopy with the fiberoptic bronchoscope. A simple method in diagnosing pleuropulmonary diseases. J Thorac Cardiovasc Surg 67:601–611

    Google Scholar 

  8. Gunnels JJ (1978) Perplexing pleural effusion. Chest 74:390–393

    Article  PubMed  CAS  Google Scholar 

  9. Ben Isaac FE, Simmons DH (1975) Flexible fiberoptic pleuroscopy: pleural and lung biopsy. Chest 67:573–576

    Article  PubMed  CAS  Google Scholar 

  10. Kerby GR, Pierce G, Ruth WE (1975) Clinical experience with pleuroscopy utilizing the bronchofiberscope. Ann Otol 84:602–606

    CAS  Google Scholar 

  11. Oldenburg FA, Newhouse MT (1979) Thoracoscopy. A safe, accurate diagnostic procedure using the rigid thoracoscope and local anesthesia. Chest 75:45–50

    Article  PubMed  Google Scholar 

  12. Ash SR, Manfredi F (1974) Directed biopsy using a small endoscope. Thoracoscopy and peritoneoscopy simplified. N Engl J Med 291:1398–1399

    PubMed  CAS  Google Scholar 

  13. Boushy SF, North LB, Helgason AH (1974) Thoracoscopy: technique and results in eighteen patients with pleural effusion. Chest 4:386–389

    Google Scholar 

  14. Mathur PN (2004) Pleuroscopy: a window to the pleura. J Bronchol 11:147–149

    Article  Google Scholar 

  15. Ernst A, Hersh CP, Thurer R et al (2002) A novel instrument for the evaluation of the pleural space. Chest 122:1530–1534

    Article  PubMed  Google Scholar 

  16. Sakuraba M, Masuda K, Hebisawa A, Sagara Y, Komatsu H (2006) Diagnostic value of thoracoscopic pleural biopsy for pleurisy under local anesthesia. ANZ J Surg 76:722–724

    Article  PubMed  Google Scholar 

  17. Ernst A, Hersh CP, Herth F, Thurer R, LoCicero J III, Beamis J, Mathur P (2002) A novel instrument for the evaluation of the pleural space: an experience in 34 patients. Chest 122:1530–1534

    Google Scholar 

  18. Munavvar M, Khan MAI, Edwards J, Waqaruddin Z, Mills J (2007) The autoclavable semirigid thoracoscope: the way forward in pleural diseases? Eur Respir J 29:571–574

    Article  PubMed  CAS  Google Scholar 

  19. Boutin C, Viallat JR, Aelony Y (1993) Thoracoscopy in pleural mesothelioma: a prospective study of 188 consecutive patients. Part 1: diagnosis. Cancer 72:389–393

    Article  PubMed  CAS  Google Scholar 

  20. Greillier L, Cavailles A, Fraticelli A et al (2007) Accuracy of pleural biopsy using thoracoscopy for the diagnosis of histologic subtype in patients with malignant pleural mesothelioma. Cancer 110:2248–2252

    Article  PubMed  Google Scholar 

  21. Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229

    Article  PubMed  CAS  Google Scholar 

  22. Hirasaki S, Tanimizu M, Moriwaki T, Hyodo I, Shinji T, Koide N, Shiratori Y (2004) Efficacy of clinical pathway for the management of mucosal gastric carcinoma treated with endoscopic submucosal dissection using an insulated-tip diathermic knife. Int Med 43:1120–1125

    Article  Google Scholar 

  23. Gotoda T (2005) A large endoscopic resection by endoscopic submucosal dissection procedure for early gastric cancer. Clin Gastroenterol Hepatol 3:S71–S73

    Article  PubMed  Google Scholar 

  24. Miyazaki S, Gunji Y, Aoki T, Nakajima K, Nabeya Y, Hayashi H, Shimada H, Uesato M, Hirayama N, Karube T, Akai T, Nikaidou T, Kouzu T, Ochiai T (2005) High en-bloc resection rate achieved by endoscopic mucosal resection with IT-knife for early gastric cancer. Hepato-Gastroenterology 52:954–958

    PubMed  Google Scholar 

  25. Lee P, Colt HG (2007) State of the art: pleuroscopy. J Thorac Oncol 2:663–670

    Article  PubMed  Google Scholar 

  26. Philip TC, Andrew C (2005) Differential diagnosis of benign and malignant mesothelial proliferations on pleural biopsies. Arch Pathol Lab Med 129:1421–1427

    Google Scholar 

  27. Butnor KJ (2006) My approach to the diagnosis of mesothelial lesions. J Clin Pathol 59:564–574

    Article  PubMed  CAS  Google Scholar 

  28. Wilson GE, Hasleton PS, Chatterjee AK (1992) Desmoplastic malignant mesothelioma: a review of 17 cases. J Clin Pathol 45:295–298

    Article  PubMed  CAS  Google Scholar 

  29. Sasada S, Kawahara K, Iwasaki T, Hirashima T, Miyazawa T (2008) An electrocautery pleural biopsy for the diagnosis of desmoplastic malignant mesothelioma during semirigid thoracoscopy. J Thorac Oncol 3:803–804

    PubMed  Google Scholar 

  30. Kawahara K, Sasada S, Nagano T, Suzuki H, Kobayashi M, Matsui K, Takata K, Yoshino T, Michida T, Iwasaki T (2008) Pleural MALT lymphoma diagnosed on thoracoscopic resection under local anesthesia using an insulation-tipped diathermic knife. Pathol Int 58:253–256

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the many nurses and physicians who participated in the care of patients in the study; Dr. Tomoki Michida for providing technical advice on using the IT knife; Dr. Atsuko Ishida for supporting the study; and Dr. Teruaki Nagano for supporting the pathologic examinations. This work was supported by grants from the Osaka Medical Research Foundation for Incurable Diseases.

Author information

Authors and Affiliations

  1. Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan

    Shinji Sasada, Yoko Kusunoki, Norio Okamoto, Hidekazu Suzuki, Masashi Kobayashi, Tomonori Hirashima & Kaoru Matsui

  2. Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka , Japan

    Kunimitsu Kawahara

  3. Department of Pulmonary Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka , Japan

    Teruo Iwasaki  & Mitsunori Ohta

  4. Department of Pulmonology, St. Marianna University School of Medicine, Kanagawa, Japan

    Teruomi Miyazawa

Authors
  1. Shinji Sasada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kunimitsu Kawahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoko Kusunoki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Norio Okamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Teruo Iwasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hidekazu Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masashi Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tomonori Hirashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kaoru Matsui
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mitsunori Ohta
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Teruomi Miyazawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shinji Sasada.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sasada, S., Kawahara, K., Kusunoki, Y. et al. A new electrocautery pleural biopsy technique using an insulated-tip diathermic knife during semirigid pleuroscopy. Surg Endosc 23, 1901–1907 (2009). https://doi.org/10.1007/s00464-008-0263-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-008-0263-8

Keywords

Search

Navigation