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JOURNAL ARTICLE

Pleural Cryobiopsy - A Systematic Review and Meta-Analysis

Majid Shafiq, Jaskaran Sethi, Muhammad S Ali, Uzair K Ghori, Tajalli Saghaie, Erik Folch
Chest 2019 October 11
31610161

BACKGROUND: Pleural biopsy using either video-assisted thoracoscopic surgery or medical pleuroscopy is the current diagnostic gold standard for pleural pathology with a high, yet imperfect, diagnostic yield. Cryobiopsy may provide greater tissue, increase depth of sampled tissue, and/or reduce crush artifact. However, its impact on diagnostic yield remains uncertain and there are potential concerns regarding its safety too. We performed a systematic review and meta-analysis in order to investigate the same.

METHODS: We performed a systematic search of MEDLINE, EMBASE, and Google Scholar for studies evaluating the performance of pleural cryobiopsy, assessing the quality of each study using the Quality Assessment, Data Abstraction and Synthesis-2 (QUADAS-2) tool. Using inverse variance weighting, we performed a meta-analysis of diagnostic yield estimations. We also reviewed specimen characteristics and complications related to the procedure.

RESULTS: Seven observational studies involving 586 pleural biopsies (311 cryobiopsies, 275 flexible forceps biopsies) were evaluated. All but one study used a semi-rigid thoracoscope. Meta-analysis generated a diagnostic yield of 96.5% for cryobiopsy and 93.1% for forceps biopsy with an inverse variance-weighted odds ratio of 1.61 (95% confidence interval: 0.71 - 3.66) and an I2 of 16%. No instances of moderate to severe bleeding were reported with cryobiopsy. A funnel plot illustrated no major publication bias.

CONCLUSIONS: Based on analysis of relatively homogenous observational data, pleural cryobiopsy is safe but does not increase diagnostic yield over flexible forceps biopsy. Adequately powered multi-center randomized trials are needed for further investigation.

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