Evaluation of safety and diagnostic yield of pleural cryobiopsies during thoracoscopy

Abstract

Background Biopsies using cryoprobe are now widely used in interventional pulmonology. There are only few data available on the use of cryotechnique through rigid thoracoscopy.Aim The aim of this work was to evaluate the diagnostic yield and safety of pleural cryobiopsies using rigid thoracoscopy.Patients and methods A total of 30 patients with undiagnosed exudative pleural effusion who underwent rigid thoracoscopy were included in our study. Biopsies were obtained from suspicious areas by rigid forceps and cryoprobe.Results A total of 30 patients with undiagnosed exudative pleural effusion have been analyzed. Histopathological results of thoracoscopic pleural biopsies revealed that the most common diagnosis was malignancy (50%), followed by tuberculosis (26.7%). Cryobiopsy specimens were larger than forceps biopsy specimens, with no difference in diagnostic yield (76.7%). Cryotechnique proved to be beneficial in cases of thin highly vascular pleura, allowing easier biopsies with lesser risk of bleeding. In cases of thickened fibrous pleura, there was no difference between both the techniques. ConclusionPleural cryobiopsies through rigid thoracoscopy is a simple and safe procedure. It has a high diagnostic yield similar to rigid forceps biopsy, and it showed better performance in thin highly vascular pleura where biopsies can be performed with minimal risk of bleeding.

Efficacy and Safety of Pleural Cryobiopsy vs. Forceps Biopsy for Evaluation of Undiagnosed Pleural Effusion: A Systematic Review and Meta-Analysis

“…All studies were published after 2015. Among those 15 studies, eight prospective studies ( 12 , 15 , 17 , 20 , 21 , 28 – 30 ), four retrospective studies ( 13 , 18 , 19 , 31 ), two cases series ( 14 , 16 ) and one randomized controlled trial ( 23 ) were analyzed, comprising 1061 biopsies (555 cryobiopsies and 506 forceps biopsies). Cryobiopsy of pleura was obtained in most patients (in 11 out of 15 studies) using cryoprobe 2.4 mm diameter.…”

“…The quality of included studies was generally fair. A higher risk of bias was mainly due to inappropriate patient selection and index test, and only few studies scored high risk in quality assessment ( 14 , 16 , 17 , 20 , 31 ). In most of studies, there was low or unclear risk of bias.…”

A Review of Medical Thoracoscopy and Its Role in Management of Malignant Pleural Effusion

“…Cryobiopsy specimens are larger than forceps biopsy specimens, with no difference in diagnostic yield. The cryotechnique proved to be beneficial in cases of thin highly vascular pleura, allowing easier biopsies with a lesser risk of bleeding [36]. Maturu and Sehgal [37] reported that cryobiopsy was larger with better preserved cellular architecture and tissue integrity than flexible forceps biopsy.…”