Intra-patient comparison of parietal pleural biopsies by rigid forceps, flexible forceps and cryoprobe obtained during medical thoracoscopy: a prospective series of 80 cases with pleural effusion.

H. Wurps,T. T. Bauer,N. Schönfeld,C. Duve,S. Griff,T. Mairinger,R. Sauer,M. Bock

doi:10.1186/s12890-016-0258-5

Abstract

BackgroundThere is only few data available on the use of cryotechnique during medical thoracoscopy.MethodsMedical thoracoscopy was performed in consecutive patients with pleural effusion. Prospectively, biopsies were taken by rigid forceps, flexible forceps and cryoprobe. Specimen size, depth and diagnostic yield were compared.Results80 Patients were included. 408 biopsies were taken (205 rigid biopsies, 104 flexible biopsies, 99 cryobiopsies). Mean surface area of rigid biopsies was 22.6 ± 20.4 mm2 (flexible biopsies: 7.1 ± 9.3 mm2, cryobiopsies: 14.4 ± 12.8 mm2). Rigid biopsies were significantly larger than cryobiopsies (p < 0.001) and flexible biopsies (p < 0.001), crybiopsies were significantly larger than flexible biopsies (p < 0.01). A deep biopsy containing fatty tissue was harvested in 63 % of rigid biopsies (cryobiopsy: 49.5 % flexible biopsy: 39.5 %). In 79/80 cases (98.7 % 95 % CI cannot be calculated) a diagnosis was obtained by rigid biopsy (cryobiopsy: 73/80 cases (91.3 % 95 % CI 86.0 – 96.5 %), flexible biopsy: 74/80 cases (92.5 % 95 % CI 88.6 – 97.4 %)). Diagnostic yield achieved with cryobiopsies was inferior to the yield of rigid biopsies (Difference: 12.7 %), but non-inferior to flexible biopsies (Difference: 6.5 %).ConclusionCryobiopsies in medical thoracoscopy are safe with high diagnostic yield, non-inferior to flexible biopsies with increased tissue quantity and quality. Cryotechnique can develop an important role in medical thoracoscopy in the near future when rigid thoracoscopy is not available.

Highlights

There is only few data available on the use of cryotechnique during medical thoracoscopy
All consecutive patients with exsudative pleural effusion of unknown etiology with indication for medical thoracoscopy were eligible for this study
As cryotechnique can be used during semi-rigid thoracoscopy, and if a rigid forceps biopsy is not available, one could speculate that this inexpensive technique could overcome the problem of a too small size of flexible forceps

Summary

Introduction

There is only few data available on the use of cryotechnique during medical thoracoscopy. Medical thoracoscopy in rigid and in semi-rigid technique is an efficient and safe procedure in patients with exudative pleural effusion of unknown origin. Biopsy specimen taken during semi-rigid-thoracoscopy are smaller than biopsies taken by rigid forceps but the diagnostic accuracy is said to be similar [1,2,3,4,5,6,7,8,9,10,11]. An advantage of semi-rigid thoracoscopy is flexibility of the Cryotechnique was introduced as early as 1968, at first for the therapeutic management of airway diseases [12]. In diagnostic series it could be demonstrated that central and pulmonary tissue

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Discussion

Conclusion