Limits...
Diagnostic Utility of Pleural Fluid Cell Block versus Pleural Biopsy Collected by Flex-Rigid Pleuroscopy for Malignant Pleural Disease: A Single Center Retrospective Analysis

View Article: PubMed Central - PubMed

ABSTRACT

Background: Some trials recently demonstrated the benefit of targeted treatment for malignant disease; therefore, adequate tissues are needed to detect the targeted gene. Pleural biopsy using flex-rigid pleuroscopy and pleural effusion cell block analysis are both useful for diagnosis of malignancy and obtaining adequate samples. The purpose of our study was to compare the diagnostic utility between the two methods among patients with malignant pleural disease with effusion.

Methods: Data from patients who underwent flex-rigid pleuroscopy for diagnosis of pleural effusion suspicious for malignancy at the National Cancer Center Hospital, Japan between April 2011 and June 2014 were retrospectively reviewed. All procedures were performed under local anesthesia. At least 150 mL of pleural fluid was collected by pleuroscopy, followed by pleural biopsies from the abnormal site.

Results: Thirty-five patients who were finally diagnosed as malignant pleural disease were included in this study. Final diagnoses of malignancy were 24 adenocarcinoma, 1 combined adeno-small cell carcinoma, and 7 malignant pleural mesothelioma (MPM), and 3 metastatic breast cancer. The diagnostic yield was significantly higher by pleural biopsy than by cell block [94.2% (33/35) vs. 71.4% (25/35); p = 0.008]. All patients with positive results on cell block also had positive results on pleural biopsy. Eight patients with negative results on cell block had positive results on pleural biopsy (lung adenocarcinoma in 4, sarcomatoid MPM in 3, and metastatic breast cancer in 1). Two patients with negative results on both cell block and pleural biopsy were diagnosed was sarcomatoid MPM by computed tomography-guided needle biopsy and epithelioid MPM by autopsy.

Conclusion: Pleural biopsy using flex-rigid pleuroscopy was efficient in the diagnosis of malignant pleural diseases. Flex-rigid pleuroscopy with pleural biopsy and pleural effusion cell block analysis should be considered as the initial diagnostic approach for malignant pleural diseases presenting with effusion.

No MeSH data available.


Related in: MedlinePlus

Cytology, cell block and biopsy specimen findings in a patient with negative result on cell block.In 63 years old male, conventional cytology shows few malignant cells with features of adenocarcinoma (Papanicolaou stain) (A). Cell block shows only red blood cells and inflammatory cells with no malignant cells (Hematoxylin and Eosin stain) (B). Biopsy specimen shows adenocarcinoma with solid growth pattern (Hematoxylin and Eosin stain) (C). Scale bar = 200 μm.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5120864&req=5

pone.0167186.g001: Cytology, cell block and biopsy specimen findings in a patient with negative result on cell block.In 63 years old male, conventional cytology shows few malignant cells with features of adenocarcinoma (Papanicolaou stain) (A). Cell block shows only red blood cells and inflammatory cells with no malignant cells (Hematoxylin and Eosin stain) (B). Biopsy specimen shows adenocarcinoma with solid growth pattern (Hematoxylin and Eosin stain) (C). Scale bar = 200 μm.

Mentions: Pleural biopsy and collection of pleural fluid for cell block were performed in one procedure during flex-rigid pleuroscopy. In 8 patients with negative results on cell block, pleural biopsy was able to contribute to rapid diagnosis. This low yield of diagnostic malignant cells on cell block may be due to hypocellularity and bleeding in the cell block preparations (Fig 1). The amount of malignant cells was few, as seen in conventional cytology, and this may have contributed to the negative cell block results. Cellularity of biological fluid samples with excessive blood decrease the quality and compromise accurate assessment of specimens [21, 22]. Although not used in the present study, in such cases, treatment with a hemolytic agent is recommended to improve the cellularity in pleural fluid samples with excessive blood [21].


Diagnostic Utility of Pleural Fluid Cell Block versus Pleural Biopsy Collected by Flex-Rigid Pleuroscopy for Malignant Pleural Disease: A Single Center Retrospective Analysis
Cytology, cell block and biopsy specimen findings in a patient with negative result on cell block.In 63 years old male, conventional cytology shows few malignant cells with features of adenocarcinoma (Papanicolaou stain) (A). Cell block shows only red blood cells and inflammatory cells with no malignant cells (Hematoxylin and Eosin stain) (B). Biopsy specimen shows adenocarcinoma with solid growth pattern (Hematoxylin and Eosin stain) (C). Scale bar = 200 μm.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120864&req=5

pone.0167186.g001: Cytology, cell block and biopsy specimen findings in a patient with negative result on cell block.In 63 years old male, conventional cytology shows few malignant cells with features of adenocarcinoma (Papanicolaou stain) (A). Cell block shows only red blood cells and inflammatory cells with no malignant cells (Hematoxylin and Eosin stain) (B). Biopsy specimen shows adenocarcinoma with solid growth pattern (Hematoxylin and Eosin stain) (C). Scale bar = 200 μm.
Mentions: Pleural biopsy and collection of pleural fluid for cell block were performed in one procedure during flex-rigid pleuroscopy. In 8 patients with negative results on cell block, pleural biopsy was able to contribute to rapid diagnosis. This low yield of diagnostic malignant cells on cell block may be due to hypocellularity and bleeding in the cell block preparations (Fig 1). The amount of malignant cells was few, as seen in conventional cytology, and this may have contributed to the negative cell block results. Cellularity of biological fluid samples with excessive blood decrease the quality and compromise accurate assessment of specimens [21, 22]. Although not used in the present study, in such cases, treatment with a hemolytic agent is recommended to improve the cellularity in pleural fluid samples with excessive blood [21].

View Article: PubMed Central - PubMed

ABSTRACT

Background: Some trials recently demonstrated the benefit of targeted treatment for malignant disease; therefore, adequate tissues are needed to detect the targeted gene. Pleural biopsy using flex-rigid pleuroscopy and pleural effusion cell block analysis are both useful for diagnosis of malignancy and obtaining adequate samples. The purpose of our study was to compare the diagnostic utility between the two methods among patients with malignant pleural disease with effusion.

Methods: Data from patients who underwent flex-rigid pleuroscopy for diagnosis of pleural effusion suspicious for malignancy at the National Cancer Center Hospital, Japan between April 2011 and June 2014 were retrospectively reviewed. All procedures were performed under local anesthesia. At least 150 mL of pleural fluid was collected by pleuroscopy, followed by pleural biopsies from the abnormal site.

Results: Thirty-five patients who were finally diagnosed as malignant pleural disease were included in this study. Final diagnoses of malignancy were 24 adenocarcinoma, 1 combined adeno-small cell carcinoma, and 7 malignant pleural mesothelioma (MPM), and 3 metastatic breast cancer. The diagnostic yield was significantly higher by pleural biopsy than by cell block [94.2% (33/35) vs. 71.4% (25/35); p = 0.008]. All patients with positive results on cell block also had positive results on pleural biopsy. Eight patients with negative results on cell block had positive results on pleural biopsy (lung adenocarcinoma in 4, sarcomatoid MPM in 3, and metastatic breast cancer in 1). Two patients with negative results on both cell block and pleural biopsy were diagnosed was sarcomatoid MPM by computed tomography-guided needle biopsy and epithelioid MPM by autopsy.

Conclusion: Pleural biopsy using flex-rigid pleuroscopy was efficient in the diagnosis of malignant pleural diseases. Flex-rigid pleuroscopy with pleural biopsy and pleural effusion cell block analysis should be considered as the initial diagnostic approach for malignant pleural diseases presenting with effusion.

No MeSH data available.


Related in: MedlinePlus