Pathak Vikas, Shepherd Ray W, Hussein Ehab, Malhotra Rajiv
Division of Pulmonary & Critical Care Medicine, WakeMed Health and Hospitals, 3024 New Bern Avenue, Suite G03, Raleigh, NC, 27610, USA.
Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA.
Lung. 2017 Jun;195(3):371-375. doi: 10.1007/s00408-017-9998-0. Epub 2017 Mar 28.
Pleural biopsy is often obtained in patients with undiagnosed exudative pleural effusion during pleuroscopy. Standard forceps have been traditionally used for the biopsy. Cryoprobes are being increasingly used for transbronchial lung biopsy as they obtain larger specimens and have less crush artifact. However, the safety and feasibility of cryoprobe biopsy compared to standard forceps for pleural biopsy has not been fully assessed.
The objective of this study was to demonstrate the safety and feasibility of cryoprobe biopsy in the pleural space using semi-rigid pleuroscopy.
Patients with idiopathic exudative pleural effusions underwent pleuroscopy. The procedure was done in the endoscopy suite with full barrier precautions and moderate sedation. Pleural biopsies were initially taken with a 2.0-mm saw-toothed forceps followed by a 2.4-mm cryoprobe (ERBECRYO, ERBE, US). The freeze time for each biopsy was 3 s.
There were a total of ten patients, five males and five females. The mean age was 69 years (SD ± 11 years). The mean number of biopsies taken from the parietal pleura using forceps was 4.5 (SD ± 1.5) vs. 3.7 (SD ± 1.4) using cryoprobe. The mean cumulative tissue volume with forceps biopsy was 80 cu. mm; the mean cumulative tissue volume with cryobiopsy was 320 cu. mm, p = 0.007. The diagnostic yields were similar in both the groups. There was no increased incidence of bleeding, chest wall injury, or pain using cryoprobe in any of the patients.
The use of cryoprobe for parietal pleural biopsy via semi-rigid pleuroscopy was feasible and safe in this small pilot study.
在胸腔镜检查期间，未确诊的渗出性胸腔积液患者常需进行胸膜活检。传统上一直使用标准活检钳进行活检。冷冻探头越来越多地用于经支气管肺活检，因为它们能获取更大的标本且挤压伪像较少。然而，与标准活检钳相比，冷冻探头用于胸膜活检的安全性和可行性尚未得到充分评估。
本研究的目的是证明使用半硬性胸腔镜在胸腔内进行冷冻探头活检的安全性和可行性。
特发性渗出性胸腔积液患者接受胸腔镜检查。该操作在内镜检查室进行，采取全面的屏障预防措施并给予适度镇静。胸膜活检最初使用2.0毫米锯齿状活检钳，随后使用2.4毫米冷冻探头（ERBECRYO，ERBE，美国）。每次活检的冷冻时间为3秒。
共有10名患者，5名男性和5名女性。平均年龄为69岁（标准差±11岁）。使用活检钳从壁层胸膜获取的活检样本平均数量为4.5个（标准差±1.5），而使用冷冻探头为3.7个（标准差±1.4）。活检钳活检的平均累积组织体积为80立方毫米；冷冻活检的平均累积组织体积为320立方毫米，p = 0.007。两组的诊断率相似。在任何患者中，使用冷冻探头均未增加出血、胸壁损伤或疼痛的发生率。
在这项小型试点研究中，通过半硬性胸腔镜使用冷冻探头进行壁层胸膜活检是可行且安全的。
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