title: Pleuroscopic cryoprobe biopsies of the pleura: a feasibility and safety study.
abstract: OBJECTIVE
  Flexi-rigid pleuroscopy is a useful tool in the work-up of pleural effusions, but pleural biopsy using flexible forceps can be difficult in some patients. This study evaluated the feasibility, safety and diagnostic value of using a flexible cryoprobe to obtain parietal pleural biopsies during pleuroscopy.
  
  
  METHODS
  This was a single-centre retrospective study. In patients undergoing diagnostic pleuroscopy, pleural biopsy using flexible forceps, followed by a flexible cryoprobe introduced through the pleuroscope, were performed. A pathologist independently reviewed all biopsies. Any complications, particularly bleeding, were recorded. All patients were followed up for ≥ 6 months (median 12 months (range 7-26)).
  
  
  RESULTS
  Twenty-two patients (21 males; median age 72 years; 14 right-sided effusions) were included. All underwent flexible forceps biopsies (FFB) and cryoprobe biopsies (CB) of pleura. FFB and CB established a definitive diagnosis in 20/22 (90%). CB successfully obtained pleural tissue suitable for histopathological analysis in all patients. CB was larger than FFB (median, 25-75 IQR of 10, 7-15.8mm vs 4, 3-8mm), and had better preserved cellular architecture and tissue integrity. Crush artefacts were less common with CB (2/22) compared with FFB (21/22). No significant bleeding was reported.
  
  
  CONCLUSIONS
  CB during flexi-rigid pleuroscopy is feasible, safe and effective. Its routine use during flexi-rigid pleuroscopy requires further evaluation.
authors.affiliation: Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Centre for Asthma, Allergy and Respiratory Research, School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Thomas
authors.forename: Shanka
authors.initials: S
authors.lastname: Karunarathne
authors.forename: Barton
authors.initials: B
authors.lastname: Jennings
authors.forename: Sue
authors.initials: S
authors.lastname: Morey
authors.forename: Siaw Ming
authors.initials: SM
authors.lastname: Chai
authors.forename: Y C Gary
authors.initials: YC
authors.lastname: Lee
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Phillips
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D003452:Cryosurgery / Q000009:adverse effects / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000473:pathology*; D010996:Pleural Effusion / Q000209:etiology*; D012189:Retrospective Studies; D013525:Surgical Instruments; D013906:Thoracoscopy / Q000009:adverse effects / Q000295:instrumentation*
keywords: biopsy; cryoprobe; malignant effusion; pleura; pleuroscopy