Pleural Cryobiopsy: A Systematic Review and Meta-Analysis

Area of Science:

• Pulmonology
• Thoracic Surgery
• Diagnostic Procedures

Background:

• Video-assisted thoracoscopic surgery and medical pleuroscopy are standard for pleural biopsy.
• These methods have a high, but not perfect, diagnostic yield for pleural pathology.
• Cryobiopsy offers potential advantages like larger tissue samples and reduced artifact, but its diagnostic impact and safety are uncertain.

Purpose of the Study:

• To systematically review and meta-analyze the diagnostic yield and safety of pleural cryobiopsy.
• To compare the performance of pleural cryobiopsy against traditional flexible forceps biopsy.

Main Methods:

• Systematic search of MEDLINE, Embase, and Google Scholar.
• Quality assessment using the Quality Assessment, Data Abstraction and Synthesis-2 tool.
• Meta-analysis of diagnostic yield using inverse variance weighting; review of specimen characteristics and complications.

Main Results:

• Seven observational studies with 586 pleural biopsies (311 cryobiopsies, 275 forceps biopsies) were analyzed.
• Diagnostic yield was 96.5% for cryobiopsy and 93.1% for forceps biopsy (OR 1.61, 95% CI 0.71-3.66, I² 16%).
• No moderate to severe bleeding complications were reported for cryobiopsy; no major publication bias was detected.

Conclusions:

• Pleural cryobiopsy is a safe procedure for diagnosing pleural conditions.
• Current evidence suggests cryobiopsy does not significantly increase diagnostic yield compared to flexible forceps biopsy.
• Further adequately powered multicenter randomized trials are necessary to definitively establish its efficacy.