title: Feasibility and safety of parietal pleural cryobiopsy during semi-rigid thoracoscopy.
abstract: OBJECTIVE
  Performing pleural biopsies during semi-rigid thoracoscopy is sometimes a difficult and time-consuming task because of the lack of mechanical power of dedicated flexible forceps in patients with thickened pleura. The purpose of this first ever pilot study was to test the feasibility of taking biopsy specimens by cryoprobe from the parietal pleura during semi-rigid thoracoscopy. Our aim was also to assess the diagnostic value and quality of specimens obtained, morphological features, feasibility of immunohistochemistry staining and possibility of DNA isolation. The secondary aim was to evaluate safety, tolerability and duration of the procedure.
  
  
  METHODS
  Fifteen patients with pleural effusion of unknown origin that underwent semi-rigid thoracoscopy were included. Biopsies were obtained using a flexible autoclavable cryoprobe 20416-032 (Erbokryo CA, ERBE, Tübingen, Germany) 2.4 mm in diameter and a semi-rigid autoclavable Olympus LTF-160 (Olympus, Tokyo, Japan) thoracoscope.
  
  
  RESULTS
  Tissue samples were obtained from 14 patients (93.3%), three from each. Of the samples, 81% were easily interpretable and 19% were interpretable with some difficulty by the pathologist. The samples were of good quality, with the level of artifacts below 25%. The specimens were adequate for histological diagnosis, immunohistochemical staining and DNA isolation. There were no moderate or major bleeding problems after the biopsies; two patients experienced pain. The median duration of three cryobiopsies (per patient) was 4 min (range 3-6 min).
  
  
  CONCLUSIONS
  Cryobiopsy during semi-rigid thoracoscopy appears worth to be evaluated in a larger prospective multicenter trial as our preliminary data were promising for efficacy and safety.
authors.affiliation: Endoscopy/Pulmonology Department, University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia.
authors.forename: Aleš
authors.initials: A
authors.lastname: Rozman
authors.affiliation: Intensive Care Unit, University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia.
authors.forename: Luka
authors.initials: L
authors.lastname: Camlek
authors.affiliation: Department of Interventional Pulmonology, University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia.
authors.forename: Mateja
authors.initials: M
authors.lastname: Marc Malovrh
authors.affiliation: Department of Pathology, University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia.
authors.forename: Izidor
authors.initials: I
authors.lastname: Kern
authors.affiliation: Oberarzt Klinik für Pneumologie, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring GmbH, Berlin, Germany. ales.rozman@klinika-golnik.si.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Schönfeld
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 / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000473:pathology / Q000601:surgery*; D010996:Pleural Effusion / Q000175:diagnosis* / Q000601:surgery; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013906:Thoracoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*
keywords: cryobiopsy; flex-rigid pleuroscopy; pleural biopsy; safety; thoracoscopy