Nakai Toshiyuki, Matsumoto Yuji, Sasada Shinji, Tanaka Midori, Tsuchida Takaaki, Ohe Yuichiro, Motoi Noriko
Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, 5-1-1, Tsukiji Chou-ku, Tokyo, Japan.
Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan.
Jpn J Clin Oncol. 2019 Jun 1;49(6):559-566. doi: 10.1093/jjco/hyz032.
Malignant pleural mesothelioma (MPM) is rarely an asbestos-related cancer with a poor prognosis that is difficult to distinguish from some benign conditions by using conventional biopsy techniques. The purpose of this study was to evaluate the utility of a novel biopsy technique using a cryoprobe during flex-rigid pleuroscopy for diagnosing MPM.
Consecutive patients who underwent pleural cryobiopsy during flex-rigid pleuroscopy from June through November 2017 to diagnose the cause of pleural effusion were collected. From these, cases ultimately diagnosed as MPM were selected. Pleural biopsies were performed by using conventional instruments followed by a cryoprobe. The obtained samples were histologically examined and compared with regard to the quality (sample size, tissue depth, and crush rate), immunohistochemical (IHC) staining, and p16 by fluorescence in situ hybridization (FISH).
In total, five patients ultimately diagnosed as MPM were enrolled. The sample collected was significantly larger for cryobiopsy than conventional biopsy (18.9 mm2 vs. 6.7 mm2, P < 0.001). Full-thickness biopsies were achieved in four cases by using cryobiopsy compared with one case by conventional biopsy. Moreover, the crush rate was significantly less for cryobiopsy than conventional biopsy (9% vs. 35%, P < 0.001). The results of IHC staining and p16 by FISH were similar between biopsy techniques. Cryobiopsy successfully led to accurate diagnosis of MPM in all cases, whereas conventional biopsy was diagnostic in one case. No severe complications developed after either biopsy technique.
Cryobiopsy during flex-rigid pleuroscopy is a feasible and convenient biopsy technique that supports precise diagnosis of MPM.
恶性胸膜间皮瘤（MPM）是一种罕见的与石棉相关的癌症，预后较差，使用传统活检技术难以与某些良性疾病相区分。本研究的目的是评估在可弯曲硬质胸腔镜检查期间使用冷冻探头的新型活检技术对MPM的诊断效用。
收集2017年6月至11月期间在可弯曲硬质胸腔镜检查时接受胸膜冷冻活检以诊断胸腔积液原因的连续患者。从中选择最终诊断为MPM的病例。先用传统器械进行胸膜活检，然后使用冷冻探头。对获得的样本进行组织学检查，并在质量（样本大小、组织深度和挤压率）、免疫组织化学（IHC）染色和荧光原位杂交（FISH）检测p16方面进行比较。
总共纳入了5例最终诊断为MPM的患者。冷冻活检采集的样本明显大于传统活检（18.9平方毫米对6.7平方毫米，P<0.001）。使用冷冻活检在4例中实现了全层活检，而传统活检仅1例。此外，冷冻活检的挤压率明显低于传统活检（9%对35%，P<0.001）。两种活检技术的IHC染色和FISH检测p16的结果相似。冷冻活检在所有病例中均成功实现了MPM的准确诊断，而传统活检仅1例诊断成功。两种活检技术后均未发生严重并发症。
可弯曲硬质胸腔镜检查期间的冷冻活检是一种可行且方便的活检技术，有助于MPM的精确诊断。
