title: Diagnostic Utility of Pleural Fluid Cell Block versus Pleural Biopsy Collected by Flex-Rigid Pleuroscopy for Malignant Pleural Disease: A Single Center Retrospective Analysis.
abstract: BACKGROUND
  Some trials recently demonstrated the benefit of targeted treatment for malignant disease; therefore, adequate tissues are needed to detect the targeted gene. Pleural biopsy using flex-rigid pleuroscopy and pleural effusion cell block analysis are both useful for diagnosis of malignancy and obtaining adequate samples. The purpose of our study was to compare the diagnostic utility between the two methods among patients with malignant pleural disease with effusion.
  
  
  METHODS
  Data from patients who underwent flex-rigid pleuroscopy for diagnosis of pleural effusion suspicious for malignancy at the National Cancer Center Hospital, Japan between April 2011 and June 2014 were retrospectively reviewed. All procedures were performed under local anesthesia. At least 150 mL of pleural fluid was collected by pleuroscopy, followed by pleural biopsies from the abnormal site.
  
  
  RESULTS
  Thirty-five patients who were finally diagnosed as malignant pleural disease were included in this study. Final diagnoses of malignancy were 24 adenocarcinoma, 1 combined adeno-small cell carcinoma, and 7 malignant pleural mesothelioma (MPM), and 3 metastatic breast cancer. The diagnostic yield was significantly higher by pleural biopsy than by cell block [94.2% (33/35) vs. 71.4% (25/35); p = 0.008]. All patients with positive results on cell block also had positive results on pleural biopsy. Eight patients with negative results on cell block had positive results on pleural biopsy (lung adenocarcinoma in 4, sarcomatoid MPM in 3, and metastatic breast cancer in 1). Two patients with negative results on both cell block and pleural biopsy were diagnosed was sarcomatoid MPM by computed tomography-guided needle biopsy and epithelioid MPM by autopsy.
  
  
  CONCLUSIONS
  Pleural biopsy using flex-rigid pleuroscopy was efficient in the diagnosis of malignant pleural diseases. Flex-rigid pleuroscopy with pleural biopsy and pleural effusion cell block analysis should be considered as the initial diagnostic approach for malignant pleural diseases presenting with effusion.
authors.affiliation: Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Chuo-Ku, Tokyo, Japan.|Department of Respiratory Medicine, Toho University Omori Medical Center, Ota-Ku, Tokyo, Japan.
authors.forename: Shion
authors.identifier: http://orcid.org/0000-0001-8933-7897
authors.initials: S
authors.lastname: Miyoshi
authors.affiliation: Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Chuo-Ku, Tokyo, Japan.|Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, Minato-Ku, Tokyo, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Sasada
authors.affiliation: Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Chuo-Ku, Tokyo, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Izumo
authors.affiliation: Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Chuo-Ku, Tokyo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Chuo-Ku, Tokyo, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Tsuchida
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D018288:Carcinoma, Small Cell / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D013906:Thoracoscopy