Diagnostic Yield And Safety Of Pleural Cryobiopsy To Diagnose Pleural Effusion

Objective Internal thoracoscopic pleural biopsy is the gold standard for the diagnosis of unexplained pleural effusion.However,the size of specimens obtained by conventional pleural biopsy under traditional semi-rigid thoracoscopy sometimes cannot meet the requirements of pathological diagnosis,while cryo-biopsy can increase the size of specimens.This article explores the diagnostic value and safety of pleural cryo-biopsy under internal thoracoscopy for unexplained pleural effusion.Methods A total of 45 patients with unexplained pleural effusion were enrolled in this study,all of whom were given medical thoracoscopy and pleural biopsy during their hospitalization in the Second Department of Respiratory Medicine,the First Affiliated Hospital of Kunming Medical University from December 2019 to November 2020.Among them,21 patients who met the inclusion criteria underwent medical thoracoscopic cryo-biopsy(CB)as the case group,24 patients underwent medical thoracoscopic conventional flexible forceps biopsy(FFB)as the control group.The value and safety of the two types of biopsy in the diagnosis of unexplained pleural effusion were judged by comparing the relevant indicators of the case group and the control group.The main outcome indicators are the diagnosis rate of CB and FFB,and the secondary indicators are the specimen size,depth,tissue compression,bleeding,pain and other complications obtained by the biopsy.Results A total of 45 patients were enrolled in this study.There were no statistically significant differences in the basic datas of age,gender,lung function,and smoking history between the two groups.The types of diseases diagnosed by internal thoracoscopic pleural biopsy are:lung adenocarcinoma with pleural metastasis,malignant pleural mesothelioma,osteosarcoma pleural metastasis,breast cancer pleural metastasis,serous ovarian cancer pleural metastasis,lung squamous cell carcinoma pleural metastasis,nerve endocrine cancer,tuberculous pleurisy,bacterial empyema,heart failure,pulmonary embolism,non-specific pleurisy.Among them,the total positive diagnosis rate of CB was 90.48%,the diagnosis rate of malignant tumors was 92.86%,and the diagnosis rate of benign lesions was 85.71%.The overall positive diagnosis rate for FFB was 75.00%,the diagnosis rate for malignant tumors was 84.62%,and the diagnosis rate for benign lesions was 63.63%.There was no significant difference in the diagnosis rate of pleural biopsy between the two(p>0.05).There were statistical differences in the size of specimens,the number of tissue pieces,the depth of biopsy,and the artifact area in CB and FFB,but there was no statistical difference in the operation time.All patients received intravenous midazolam,remifentanil and topical ropivacaine anesthetics before thoracoscopic surgery.Intraoperative bleeding was a small amount of bleeding,with an average bleeding volume of 1-3 mL.There were only 4 FFB patients and 1 patient with cryo-biopsy developed mild pain and walked back to the ward after the operation.Conclusion Internal thoracoscopic cryo-biopsy of pleural cannot significantly improve the diagnosis rate of pleural effusion,but it can obtain larger specimens with more complete tissue structure,and there is no significant increase in complications.It is a safe and effective technique.In some specific cases,it benefits more than conventional biopsy forceps and has more potential applications in the future.