Visceral pleural biopsy under medical thoracoscopy for the diagnosis of lung adenocarcinoma

Abstract

Medical thoracoscopy is a minimally invasive single‐port endoscopic technique that provides direct visualization of the pleural surface and allows for diagnostic procedures. The diagnostic yield of medical thoracoscopy is high and is generally based on parietal pleural biopsy findings. Pleural biopsies are valuable for a diagnosis. However, visceral pleural biopsies are uncommon because of the risk of prolonged air leak. In this study, we report a rare case of the successful diagnosis of lung adenocarcinoma, based on the findings of visceral pleural biopsy under medical thoracoscopy. To avoid lung injury and pneumothorax, we focused on maintaining the thoracoscope and biopsy forceps in a straight angle as much as possible. While looking straight ahead at the visceral pleural nodule as closely as possible, biopsy samples were carefully obtained while confirming that the normal lung was not held. With careful consideration, visceral pleural biopsies may expand the diagnostic capability of medical thoracoscopy.

A case of a thoracic mass negative on thoracentesis diagnosed by cryobiopsy from the visceral pleura

“…There is one previous report of a biopsy from the visceral pleura. Terashita et al safely performed a forceps biopsy from the visceral pleura in an 82‐year‐old woman with negative pleural fluid cytology and diagnosed lung adenocarcinoma 2 …”

“…1 To reduce pneumothorax, a previous study reported pressing thoracoscopes and biopsy forceps against the nodule vertically to avoid grasping the normal lung. 2 In the present study, we selected a convex-shaped mass in the thoracic cavity; a biopsy specimen was obtained by keeping the side of the cryoprobe tip against the most convex part of the tumour in the thoracic cavity to avoid contact with the normal lung.…”

“…However, Terashita et al safely performed a forceps biopsy from the visceral pleura during thoracoscopy under local anaesthesia and diagnosed lung adenocarcinoma. 2 Here we report a case of a patient who was negative on thoracentesis and underwent cryobiopsy from the visceral pleura by thoracoscopy under local anaesthesia. The technique was performed safely and led to a diagnosis.…”

“…In thoracoscopy under local anaesthesia, biopsies are usually taken from the parietal pleura. However, Terashita et al safely performed a forceps biopsy from the visceral pleura during thoracoscopy under local anaesthesia and diagnosed lung adenocarcinoma 2 …”

Pleural staging using local anesthetic thoracoscopy in dry pleural dissemination and minimal pleural effusion

“…In particular, visceral pleural biopsy as well as LAT in patients with minimal or no PE is listed as a level II technique that should be performed by more experienced practitioners with a major interest in pleural diseases 11 . Although some argue that visceral pleural biopsy should be avoided because of the risk of prolonged air leak, 20 there has been a case report of safe and successful diagnosis 21 …”