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CLOSED PLEURAL BRUSHING: A NEW DIAGNOSTIC TOOL FOR PLEURAL LESIONS

Fukushima Medical University, Fukushima, Japan

PURPOSE: Pleural diseases, particularly cancerous lesions, are sometimes difficult to diagnose. Cytopathological specimens from pleural effusion or closed biopsies using Cope's needle are not always diagnostic. We have developed a simple device for pleural brushing cytology, and evaluate the efficacy and safety of this new procedure.

METHODS: We developed a cytology brush for insertion into the pleural space through a trocar under local anesthesia. The device resembles a bronchial brush used for flexible bronchoscopy. The head of the brush can be bent to form a right angle in the pleural cavity by pulling a handle. The bent brush is pulled with a trocar to attach onto the parietal pleura, and then rotated over the surface of the pleura to collect cells. The brush is rinsed in a tube containing saline to retrieve cells, and centrifuged collections are prepared for cytopathological examination. We applied this method to 8 consecutive patients whose cytopathological samples from exudative pleural effusion were not diagnostic.

RESULTS: Pleural-brushed materials from 7 patients were diagnostic, with 4 cases of primary lung cancer, 1 metastatic cancer from the nasal cavity, 1 malignant mesothelioma, and 1 case of rheumatoid granulomatous pleuritis. The remaining case involved metastatic squamous cell carcinoma from the tongue and was diagnosed on subsequent thoracoscopy, showing malignant cells disseminating throughout subpleural tissues without invading to the pleural surface. No adverse events were encountered. Given the sufficient amounts of brushed cells, special staining for carletinin was also available in some cases.

CONCLUSION: This new brushing device allows effective, safe diagnosis of pleural lesions. Limitations for this procedure comprise the requirement for appropriate amounts of effusion, and sampling is possible only from the surface of the parietal pleura.

CLINICAL IMPLICATIONS: This device would be utilized for the diagnosis of pleural diseases with cytopathologically undetermined effusion.

DISCLOSURE: Takashi Ishida, None.