A team of surgeons in Maryland have demonstrated how using a standard biopsy tool in a new way could improve the biopsy process for certain mesothelioma patients.
An aggressive cancer of the pleural lining around the lungs, malignant pleural mesothelioma usually requires a tissue biopsy to make a definitive diagnosis. Often this is done using a rigid tool called a thoracoscope inserted into the chest wall while the patient is under general anesthesia. However, mesothelioma doctors at Walter Reed National Military Medical Center detail the case of a 79-year-old suspected mesothelioma patient whose biopsy was done in a minimally-invasive way, under conscious sedation, thanks to the novel use of a standard tool.
Although the patient had several of the common signs of mesothelioma, including shortness of breath and a history of asbestos exposure, a test of the fluid around his lungs showed no malignant cells. His doctors elected to perform a minimally invasive diagnostic procedure called pleuroscopy. Pleuroscopy involves the use of flexible tools inserted into the chest through a semi-rigid catheter. It is performed through a small incision in the chest wall with the patient heavily sedated but not asleep.
In the reported case, when the pleuroscopy was exploring the space between the layers of lung lining where mesothelioma most often occurs, it found the space to be “studded with polypoid tumors”. The soft, fragile consistency of these tumors would have made it nearly impossible to obtain a large enough tissue sample using the flexible tools. But the patient’s doctors found a way around the problem by using a basket retrieval device designed for use in the gastrointestinal and respiratory tracts.
“This case illustrates the novel use of the endoscopic basket retrieval device within the pleural space to overcome some of the inherent limitations of semirigid pleuroscopic biopsies and increase the yield for diagnosis with this minimally invasive technique,” write the researchers in a recent issue of Chest. In mesothelioma and other pleural tumors, small tissue samples are often not enough to make a diagnosis. By using the basket retrieval device, the surgeons avoided having to perform a more invasive procedure and still obtained an entire tumor (1.5 cm) to diagnose mesothelioma.
Philip, A, et al, “Netting the Diagnosis: A Novel Use of an Endoscopic Basket Retrieval Device Combined With Pleuroscopy to Biopsy and Diagnose Malignant Mesothelioma”, October 1, 2012, Chest, Meeting Abstracts.