Achieving Molecular Profiling in Pleural Biopsies

Sundaralingam, Anand; Aujayeb, Avinash; Akca, Baki; Tiedeman, Clare; George, Vineeth; Carling, Michael; Brown, Jennifer R.; Banka, Radhika; Addala, Dinesh; Bedawi, Eihab; Hallifax, Rob; Iqbal, Beenish; Denniston, Poppy; Tsakok, Maria; Kanellakis, Nikolaos I.; Vafai-Tabrizi, Florian; Bergman, Michael; Funk, Georg‐Christian; Benamore, Rachel; Wrightson, John; Rahman, Najib M.

doi:10.1016/j.chest.2022.11.019

Cited by 11 publications

(4 citation statements)

References 20 publications

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“…The high yield of thoracoscopic biopsies for “actionable” histology is supported by recent evidence showing the superiority of thoracoscopic biopsies in achieving full molecular profiling, when compared to CT or ultrasound-guided pleural biopsies ( 17 , 20 ). These various considerations speak to the importance of MT as an option for patients with suspected MPE.…”

Section: Discussionmentioning

confidence: 95%

Diagnostic value and safety of medical thoracoscopy in undiagnosed pleural effusions—a prospective observational cohort study

Goh,

Leong,

Young

et al. 2024

J Thorac Dis

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Background With the need for “actionable histology” in the current era of targeted cancer treatment, and the increasing practice of upfront thoracoscopy (without a prior diagnostic thoracentesis) or a “biopsy first” approach in suspected malignant pleural effusions (MPEs), we sought to prospectively evaluate the diagnostic accuracy, including full molecular profiling of cancer, and safety of medical thoracoscopy (MT) at a tertiary referral hospital. Methods Patients with MT performed for an undiagnosed pleural effusion between January 2020 and December 2022 were included in this observational cohort study. All procedures were performed with a semirigid thoracoscope under conscious sedation. Clinical outcomes and adverse events were recorded prospectively. Results We evaluated 141 patients, with a mean age of 67±12 years. Talc poudrage was performed in 67 (47.5%) patients with a median of 2 [interquartile range (IQR), 1–4] hospitalisation days after MT. Upfront thoracoscopy was performed in approximately half (55.3%) of patients. The overall diagnostic accuracy of MT was 95.7% in our cohort. A final diagnosis of cancer was made in 116 (82.3%) patients, with lung (67.2%) and breast cancer (8.6%) the most common. The diagnostic sensitivity of MT for malignancy was 94.8%, and molecular profiling of relevant cancer types for oncogenic mutations was achieved in all patients with malignancy seen on histopathology. The most common non-malignant diagnosis was tuberculous pleuritis in 14 patients (9.9%). Major complications occurred in 3 (2.1%) patients. Two patients had re-expansion pulmonary edema that resolved with low flow oxygen supplementation in the general ward, and one patient required intensive care unit admission for cardiac tamponade from a malignant pericardial effusion. There were no cases of mortality, bleeding complications or persistent air leaks. Conclusions MT is a well-tolerated and effective option for the evaluation of undiagnosed pleural effusions. With expanding utility and expertise with MT and other pleural interventions, the challenge for respiratory physicians is integrating these into expeditious diagnostic and effective therapeutic pathways, individualised to patients’ needs.

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Section: Discussionmentioning

confidence: 95%

Diagnostic value and safety of medical thoracoscopy in undiagnosed pleural effusions—a prospective observational cohort study

Goh,

Leong,

Young

et al. 2024

J Thorac Dis

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“…However, image guided biopsies appear to be inferior to thoracoscopy biopsies specifically for the yield of molecular profiling and 'actionable histology' for cancer. In a retrospective analysis comparing the yield of actionable histology, the yield from thoracoscopic biopsies (95%) was significantly superior to CT scan guided biopsies (86%) and ultrasound guided biopsies (77%) 42 .…”

Section: Image Guided Pleural Biopsymentioning

confidence: 97%

The role of interventional pulmonology in the diagnosis and management of undiagnosed pleural effusions

Junyang Goh,

Mei Chew,

Rahman

2024

BRN

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In recent years, there has been an unprecedented drive for quality research in pleural disease, and advances in technology that have changed the landscape of interventional pulmonology, particularly for patients with undiagnosed pleural effusions. With a range of pleural procedures now available to the pulmonologist, the challenge is integrating these into a diagnostic and therapeutic pathway that is individualised to the patient's needs, while also providing expeditious diagnostic evaluation, limiting the number of procedures, and shifting care to the ambulatory setting. This review aims to summarise the important evidence related to pleural procedures, discuss their advantages and limitations, and describe their role in the management of undiagnosed pleural effusions.

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“…The highest yield from cytological analysis has been reported with breast and ovarian cancers; however, in the age of targeted therapies further sampling may still be required to accurately define appropriate anti-cancer therapy. Biopsies via LAT have been proven to be the most useful for molecular analysis in a retrospective case review by S undaralingam et al [ 10 ]. If the pre-test probability of a cancer such as mesothelioma is high, then a direct to LAT approach is advocated as the cytological yield can be as low as 6%, and invasion into the adipose tissue and parietal pleura is needed to complete tumour characterisation [ 3 , 9 ].…”

Section: Who Should Undergo a Medical Thoracoscopy?mentioning

confidence: 99%

Use of medical thoracoscopy in managing pleural malignancy

Aujayeb,

Astoul

2024

Breathe

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Local anaesthetic “medical” thoracoscopy is an important tool for the diagnosis and management of a unilateral pleural effusion. It is performed under conscious sedation and has a high diagnostic yield. Clinical experience has demonstrated that thoracoscopy is a safe procedure. This article is an expert review of various aspects of the procedures from two experienced practitioners and we suggest areas for potential future research.

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Achieving Molecular Profiling in Pleural Biopsies

Cited by 11 publications

References 20 publications

Diagnostic value and safety of medical thoracoscopy in undiagnosed pleural effusions—a prospective observational cohort study

Diagnostic value and safety of medical thoracoscopy in undiagnosed pleural effusions—a prospective observational cohort study

The role of interventional pulmonology in the diagnosis and management of undiagnosed pleural effusions

Use of medical thoracoscopy in managing pleural malignancy

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