title: Pleuroscopic punch biopsy using insulated-tip diathermic knife-2 for the diagnosis of desmoplastic malignant mesothelioma.
abstract: Desmoplastic malignant mesothelioma (DMM) is a rare subtype of malignant pleural mesothelioma (MPM) and is often difficult to distinguish from pleural fibrosis and reactive mesothelial hyperplasia, especially if the biopsy samples are small. We performed full-thickness pleural biopsy on a lesion suspected to be DMM using an insulated-tip diathermic knife-2 (IT knife-2) during flex-rigid pleuroscopy. IT knife-2 is a novel electrosurgical device for endoscopic submucosal dissection in the early gastrointestinal cancer. It consists of a needle knife with 3 short blades at the distal end attached to an insulated ceramic tip. A 54-year-old man presenting with chest wall mass and thickened pleura, in whom a computed tomography-guided percutaneous needle aspiration had remained negative, underwent flex-rigid pleuroscopy for definitive diagnosis. While applying electric current, we used the IT knife-2 to incise the pleura in a circular shape just above the endothoracic fascia. The incised pleura was removed by forceps and examined pathologically. The microscopic examination was compatible with DMM. We discovered that pleuroscopic punch biopsy using IT knife-2 can diagnose DMM. Use of IT knife-2 during flex-rigid pleuroscopy can obtain sufficient samples from densely thickened pleura, which is difficult to diagnose with small biopsies.
authors.affiliation: *Department of Endoscopy, Respiratory Endoscopy Division Departments of †Thoracic Surgery ‡Pathology and Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Kyohei
authors.initials: K
authors.lastname: Masai
authors.forename: Shinji
authors.initials: S
authors.lastname: Sasada
authors.forename: Takehiro
authors.initials: T
authors.lastname: Izumo
authors.forename: Tomoko
authors.initials: T
authors.lastname: Taniyama
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Christine
authors.initials: C
authors.lastname: Chavez
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sakurai
authors.forename: Koji
authors.initials: K
authors.lastname: Tsuta
authors.forename: Takaaki
authors.initials: T
authors.lastname: Tsuchida
mesh_terms: D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods; D003937:Diagnosis, Differential; D004564:Electrocoagulation / Q000295:instrumentation*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis* / Q000473:pathology; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D010994:Pleura / Q000473:pathology; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000473:pathology; D013906:Thoracoscopy / Q000295:instrumentation / Q000379:methods*