title: Safety and Feasibility of Pleural Cryobiopsy Compared to Forceps Biopsy During Semi-rigid Pleuroscopy.
abstract: Pleural biopsy is often obtained in patients with undiagnosed exudative pleural effusion during pleuroscopy. Standard forceps have been traditionally used for the biopsy. Cryoprobes are being increasingly used for transbronchial lung biopsy as they obtain larger specimens and have less crush artifact. However, the safety and feasibility of cryoprobe biopsy compared to standard forceps for pleural biopsy has not been fully assessed.
  
  
  
  The objective of this study was to demonstrate the safety and feasibility of cryoprobe biopsy in the pleural space using semi-rigid pleuroscopy.
  
  
  
  Patients with idiopathic exudative pleural effusions underwent pleuroscopy. The procedure was done in the endoscopy suite with full barrier precautions and moderate sedation. Pleural biopsies were initially taken with a 2.0-mm saw-toothed forceps followed by a 2.4-mm cryoprobe (ERBECRYO, ERBE, US). The freeze time for each biopsy was 3 s.
  
  
  
  There were a total of ten patients, five males and five females. The mean age was 69 years (SD ± 11 years). The mean number of biopsies taken from the parietal pleura using forceps was 4.5 (SD ± 1.5) vs. 3.7 (SD ± 1.4) using cryoprobe. The mean cumulative tissue volume with forceps biopsy was 80 cu. mm; the mean cumulative tissue volume with cryobiopsy was 320 cu. mm, p = 0.007. The diagnostic yields were similar in both the groups. There was no increased incidence of bleeding, chest wall injury, or pain using cryoprobe in any of the patients.
  
  
  
  The use of cryoprobe for parietal pleural biopsy via semi-rigid pleuroscopy was feasible and safe in this small pilot study.
authors.affiliation: Division of Pulmonary & Critical Care Medicine, WakeMed Health and Hospitals, 3024 New Bern Avenue, Suite G03, Raleigh, NC, 27610, USA. drvikaspathak@gmail.com.
authors.forename: Vikas
authors.initials: V
authors.lastname: Pathak
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA.
authors.forename: Ray W
authors.initials: RW
authors.lastname: Shepherd
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Kettering Medical Center, Dayton, OH, USA.
authors.forename: Ehab
authors.initials: E
authors.lastname: Hussein
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Malhotra
mesh_terms: 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; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010994:Pleura / Q000473:pathology*; D010996:Pleural Effusion / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013525:Surgical Instruments; D013906:Thoracoscopy / Q000009:adverse effects / Q000295:instrumentation
keywords: Cryobiopsy; Pleural cryobiopsy; Pleuroscopy