Pleuroscopic punch biopsy using insulated-tip diathermic knife-2 for the diagnosis of desmoplastic malignant mesothelioma

Kyohei Masai, Shinji Sasada, Takehiro Izumo, Tomoko Taniyama, Yukiko Nakamura, Christine Chavez, Hiroyuki Sakurai, Koji Tsuta, Takaaki Tsuchida

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Summary: Desmoplastic malignant mesothelioma (DMM) is a rare subtype of malignant pleural mesothelioma (MPM) and is often difficult to distinguish from pleural fibrosis and reactive mesothelial hyperplasia, especially if the biopsy samples are small. We performed full-thickness pleural biopsy on a lesion suspected to be DMM using an insulated-tip diathermic knife-2 (IT knife-2) during flex-rigid pleuroscopy. IT knife-2 is a novel electrosurgical device for endoscopic submucosal dissection in the early gastrointestinal cancer. It consists of a needle knife with 3 short blades at the distal end attached to an insulated ceramic tip. A 54-year-old man presenting with chest wall mass and thickened pleura, in whom a computed tomography-guided percutaneous needle aspiration had remained negative, underwent flex-rigid pleuroscopy for definitive diagnosis. While applying electric current, we used the IT knife-2 to incise the pleura in a circular shape just above the endothoracic fascia. The incised pleura was removed by forceps and examined pathologically. The microscopic examination was compatible with DMM. We discovered that pleuroscopic punch biopsy using IT knife-2 can diagnose DMM. Use of IT knife-2 during flex-rigid pleuroscopy can obtain sufficient samples from densely thickened pleura, which is difficult to diagnose with small biopsies.

Original languageEnglish
Pages (from-to)345-348
Number of pages4
JournalJournal of Bronchology and Interventional Pulmonology
Issue number4
Publication statusPublished - 2013 Oct
Externally publishedYes


  • Desmoplastic malignant mesothelioma
  • Flex-rigid pleuroscope
  • Full-thickness pleura
  • Insulated-tip diathermic knife-2
  • Pleuroscopic punch biopsy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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