Medical Thoracoscopy

Dhooria, Sahajal et al: (2019): Pleural Cryobiopsy versus Flexible Forceps Biopsy in Subjects with Undiagnosed Exudative Pleural Effusions Undergoing Semirigid Thoracoscopy: A Crossover Randomized Trial (COFFEE Trial). Respiration; international review of thoracic diseases 98 (2), S. 133–141.
 

In this prospective study cryobiopsy (reusable, 2.4mm) and flexible forceps biopsy were compared for the diagnosis of pleural effusion in medical thoracoscopy. The same patients (n=50) underwent both forceps and cryobiopsy in a randomized order using semirigid thoracoscopy. Cryobiopsy specimens were significantly larger (median size 7.0mm vs. 4.0mm; p < 0.001) and had a significantly greater depth (down to the pleural fat or deeper: 65.2 vs. 40.8%; p = 0.02) than specimens from forceps biopsy. The duration of the cryobiopsy procedure was also significantly shorter than that of forceps biopsy (median duration 10 vs. 15 min; p < 0.001). The diagnostic yield (78.0% vs. 76.0%), difficulty of performing the biopsy, and severity of bleeding were similar in the two procedures. The authors concluded that “The diagnostic yield of pleural cryobiopsy was comparable to forceps biopsy during semirigid thoracoscopy.”
 

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Botana Rial, Maribel et al: (2020): Diagnostic Yield and Safety of Pleural Cryobiopsy during Medical Thoracoscopy to Diagnose Pleural Effusion. A Systematic Review and Meta-Analysis. Archivos de bronconeumologia.

This meta-analysis compared the diagnostic yield and safety of pleural cryobiopsy and flexible forceps biopsy and evaluated 7 studies involving 356 patients. The diagnostic yield was comparable between the techniques (cryobiopsy: 95% (95% CI 92-97) vs. forceps biopsy: 91% (95% CI 87- 94)). Slight bleeding occurred more often during procedures with flexible forceps (85%, 95%; CI 79-90) than with cryobiopsy (67%, 95% CI 62-72; P< 0.001). Furthermore, cryobiopsy specimens were larger, and fewer artifacts were detected. A pooled analysis of the detection of molecular changes could not be performed. Heterogeneity was moderate to high, but the quality of the studies was acceptable. The authors concluded that “Pleural cryobiopsy is a safe technique with a high yield for etiological diagnosis of pleural effusion, and larger specimens with fewer artifacts are obtained. Molecular determinations should be investigated in more depth.”
 

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