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Pulmonary Procedures |

Safety and Feasibility of Pleural Cryobiopsy Compared to Forceps Biopsy During Medical Pleuroscopy

Vikas Pathak, MD; Ray Shepherd, MD; Samira Shojaee, MD; Ehab Hussein, DO; Rajiv Malhotra, DO
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Virginia Commonwealth University, Richmond, VA


Chest. 2015;148(4_MeetingAbstracts):809A. doi:10.1378/chest.2273188
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Abstract

SESSION TITLE: Interventional Pulmonology Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Pleuroscopy is a procedure in which a sterile endoscope is inserted into the pleural space. The lung can be examined, talc instilled, chest tubes placed and pleural biopsies obtained. The procedure is performed in patients with idiopathic exudative pleural effusion. Conventionally forceps biopsies are limited by the size of the forceps and the technique. Cryobiopsy is a technique of using a sterile probe cooled by CO2 expansion. The cooled probe draws moisture out of the tissue and freezes with it creating a bond. This technique might reduce crush artifact and obtain larger specimens. We explored the feasibility and safety of using cryoprobe for pleural biopsy.

METHODS: Patients with idiopathic exudative pleural underwent pleuroscopy. The procedure was done in the bronchoscopy suite with full barrier precautions and moderate sedation. Pleural biopsies were initially taken with a 2.8mm saw-toothed forceps followed by cryoprobe. The freeze time was 3-5 seconds.

RESULTS: There were total 9 patients, 5 males and 4 females. The mean number of biopsies taken using forceps was 5 (SD+/- 1.5) vs. 4 (SD +/-1.3) using cryoprobe. The mean size of the biopsy using forceps was 0.9 mm (SD +/- 0.5) vs. 1.2 mm (SD +/-0.3) using cryoprobe. The diagnostic yields were similar in both the groups (forceps and cryoprobe). There was no increased incidence of bleeding, chest wall injury or pain using cryoprobe in any of the patients.

CONCLUSIONS: Use of cryoprobe was feasible and safe in this small pilot study.

CLINICAL IMPLICATIONS: A multicenter trial will help expand the use of cryoprobe for pleural biopsy. Future study will also help demonstrate if the diagnostic yield of cryoprobe biopsy is better than forceps biopsy. Cryobiopsy uses less disposable and potentially shortens procedure time. This may result in cost and safety benefits.

DISCLOSURE: The following authors have nothing to disclose: Vikas Pathak, Ray Shepherd, Samira Shojaee, Ehab Hussein, Rajiv Malhotra

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