Wang Xiao-Bo, Yin Yan, Miao Yuan, Eberhardt Ralf, Hou Gang, Herth Felix J, Kang Jian
Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China.
Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China.
J Thorac Dis. 2016 Nov;8(11):E1555-E1559. doi: 10.21037/jtd.2016.11.92.
Diagnosing pleural effusion is challenging, especially in patients with malignant or benign fibrothorax, which is difficult to sample using standard flexible forceps (SFF) via flex-rigid pleuroscopy. An adequate sample is crucial for the differential diagnosis of malignant fibrothorax (malignant pleural mesothelioma, metastatic lung carcinoma, etc.) from benign fibrothorax (benign asbestos pleural disease, tuberculous pleuritis, etc.). Novel biopsy techniques are required in flex-rigid pleuroscopy to improve the sample size and quality. The SB knife Jr, which is a scissor forceps that uses a mono-pole high frequency, was developed to allow convenient and accurate resection of larger lesions during endoscopic dissection (ESD). Herein, we report two patients with fibrothorax who underwent a pleural biopsy using an SB knife Jr to investigate the potential use of this tool in flex-rigid pleuroscopy when pleural lesions are difficult to biopsy via SFF. The biopsies were successful, with sufficient size and quality for definitive diagnosis. We also successfully performed adhesiolysis with the SB knife Jr in one case, and adequate biopsies were conducted. No complications were observed. Electrosurgical biopsy with the SB knife Jr during flex-rigid pleuroscopy allowed us to obtain adequate samples for the diagnosis of malignant versus benign fibrothorax, which is usually not possible with SFF. The SB knife Jr also demonstrated a potential use for pleuropulmonary adhesions.
诊断胸腔积液具有挑战性，尤其是对于患有恶性或良性纤维胸的患者，使用标准的柔性活检钳（SFF）通过软硬结合的胸腔镜难以采集样本。获取足够的样本对于鉴别恶性纤维胸（恶性胸膜间皮瘤、转移性肺癌等）与良性纤维胸（良性石棉性胸膜疾病、结核性胸膜炎等）至关重要。在软硬结合的胸腔镜检查中需要新的活检技术来提高样本量和质量。SB knife Jr是一种使用单极高频的剪式活检钳，旨在在内镜下黏膜下剥离术（ESD）期间方便、准确地切除较大病变。在此，我们报告两名纤维胸患者，他们使用SB knife Jr进行了胸膜活检，以研究当胸膜病变难以通过SFF进行活检时，该工具在软硬结合胸腔镜检查中的潜在用途。活检成功，样本大小和质量足以进行明确诊断。我们还在一例患者中使用SB knife Jr成功进行了粘连松解，并进行了充分的活检。未观察到并发症。在软硬结合的胸腔镜检查中使用SB knife Jr进行电外科活检使我们能够获得足够的样本用于诊断恶性与良性纤维胸，而这通常是SFF无法做到的。SB knife Jr在胸膜肺粘连方面也显示出潜在用途。
