Optimizing Tissue Sampling During Medical Pleuroscopy for Diagnosis of Malignant Pleural Effusion Due to Lung Cancer: Study Criopleura

Abstract Cryobiopsy has emerged in recent years as a tool of growing interest in the diagnosis of non-small cell lung cancer (NSCLC). We conducted the first study with the primary objective of analyzing the techniques of biopsy during semirigid pleuroscopy to compare the quality of cryobiopsies versus conventional forceps biopsies, including expected tissue outcomes and the feasibility of histological characterization and molecular testing, of malignant pleural effusion (MPE). Prospective study including 14 caucasian patients with MPE due to NSCLC who underwent semirigid pleuroscopy with cryobiopsies. The median biopsy size for conventional flexible forceps and cryoprobe was 2.5 mm (1.5–3.2 mm) and 5.5 mm (3.8–7.6 mm), respectively (p = 0.07). The number of biopsies also differed: flexible forceps: 5 (4-6.25) biopsies vs cryoprobe: 3 (3–4) biopsies(p = 0.01). The tumor/non-tumor ratio in the conventional forceps sample was 2.4 (1.2–5.9), while in the cryoprobe sample, it was 3.6 (1.2–10) (p = 0.09). Only in one case, the samples obtained during semirigid pleuroscopy were insufficient for molecular diagnosis. The incorporation of cryobiopsy into semirigid pleuroscopy could reduce the number of biopsies required, the sample size was significantly larger, as was the tumor/non-tumor ratio. This technique could shortening procedure time and facilitating tissue collection without increasing procedural risks.