Nishii Yoichi, Sakaguchi Tadashi, Esumi Seiya, Inoue Remi, Nakanishi Kentaro, Fujiura Yuki, Suzuki Yuta, Ito Kentaro, Hataji Osamu, Iketani Akemi, Furuyama Tatsuhiro, Nakamura Yuki, Ito Yuta, Yasui Hiroki, D'Alessandro-Gabazza Corina N, Yasuma Taro, Fujimoto Hajime, Gabazza Esteban C, Kobayashi Tetsu, Taguchi Osamu
Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Japan.
Department of Pathology, Matsusaka Municipal Hospital, Matsusaka, Japan.
Respiration. 2025 Jul 2:1-11. doi: 10.1159/000546840.
Pleuroscopy has significantly improved the diagnostic yield for pleural diseases, including lung cancer with pleural dissemination. However, obtaining suitable samples for genetic analysis in non-small cell lung cancer (NSCLC) remains challenging. Cryobiopsy enables the collection of larger specimens during pleuroscopy. This retrospective study evaluated the impact of incorporating cryobiopsy with forceps biopsy during pleuroscopy on specimen suitability and the success rate of genetic analysis.
This study included 37 patients with suspected malignant pleural effusion who underwent pleuroscopy with both cryobiopsy and forceps biopsy under local anesthesia at our institution between January 2020 and May 2024. The Oncomine Dx Target Test, a next-generation sequencing assay, was performed on all suitable specimens. Pleuroscopic findings included pleural thickening, granular lesions, small nodules, large nodules, and masses larger than 30 mm. Final pathological diagnoses included 23 cases of NSCLC, 5 cases of small cell lung cancer, 7 cases of malignant pleural mesothelioma, 1 case of diffuse large B-cell lymphoma, and 1 case of metastatic pancreatic cancer.
The overall diagnostic yield of pleuroscopy was 97.3%. Cryobiopsy achieved a diagnostic yield of 97.3%, while forceps biopsy achieved 89.2 percent, with no statistically significant difference. The diagnostic yield plateaued after the fourth forceps biopsy and after the second cryobiopsy. In patients with NSCLC, specimens obtained by cryobiopsy were significantly more likely to be suitable for genetic analysis (49.1%) than those obtained by forceps biopsy (24.7%; p = 0.004). The combined suitability for genetic analysis of both forceps and cryobiopsy specimens was 69.6%, with a 100% success rate in performing the analysis. Larger pleural tumor size was significantly associated with higher specimen suitability (81.3% vs. 28.6%; p = 0.026). No complications requiring therapeutic intervention were observed.
This exploratory study demonstrates that combining cryobiopsy with forceps biopsy during pleuroscopy improves specimen suitability for genetic analysis, with pleural tumor size emerging as a key determinant factor. Further prospective studies are warranted to validate these findings.
胸腔镜检查显著提高了胸膜疾病的诊断率，包括伴有胸膜播散的肺癌。然而，获取适合非小细胞肺癌（NSCLC）基因分析的样本仍然具有挑战性。冷冻活检能够在胸腔镜检查期间采集更大的标本。这项回顾性研究评估了胸腔镜检查期间将冷冻活检与钳取活检相结合对标本适用性和基因分析成功率的影响。
本研究纳入了37例疑似恶性胸腔积液的患者，他们于2020年1月至2024年5月在我院接受了局部麻醉下的胸腔镜检查，同时进行了冷冻活检和钳取活检。对所有合适的标本进行了Oncomine Dx Target Test（一种二代测序检测）。胸腔镜检查结果包括胸膜增厚、颗粒状病变、小结节、大结节以及直径大于30mm的肿块。最终病理诊断包括23例NSCLC、5例小细胞肺癌、7例恶性胸膜间皮瘤、1例弥漫性大B细胞淋巴瘤和1例转移性胰腺癌。
胸腔镜检查的总体诊断率为97.3%。冷冻活检的诊断率为97.3%，钳取活检的诊断率为89.2%，两者无统计学显著差异。在第四次钳取活检和第二次冷冻活检后，诊断率趋于平稳。在NSCLC患者中，冷冻活检获取的标本比钳取活检获取的标本更有可能适合基因分析（49.1%对24.7%；p = 0.004）。钳取活检和冷冻活检标本的基因分析综合适用性为69.6%，分析成功率为100%。较大的胸膜肿瘤大小与较高的标本适用性显著相关（81.3%对28.6%；p = 0.026）。未观察到需要治疗干预的并发症。
这项探索性研究表明，胸腔镜检查期间将冷冻活检与钳取活检相结合可提高标本对基因分析的适用性，胸膜肿瘤大小是一个关键决定因素。需要进一步的前瞻性研究来验证这些发现。
