The Diagnostic yield and safety of pleural cryobiopsy using a flexible bronchoscope: a retrospective cohort study
Keywords:
Pleural effusion, Cryobiopsy, Pleuroscopy, Flexible bronchoscope, Diagnostic yieldAbstract
Abstract
Background
Pleuroscopy is a well-established diagnostic tool for undiagnosed exudative pleural effusion, conventionally performed with rigid or semi-rigid thoracoscopes when less invasive methods fail. Pleural cryobiopsy improves diagnostic yield and tissue quality, but data on its use with a flexible bronchoscope remain limited. In this study, we assessed the diagnostic yield, adequacy for molecular testing, safety, and feasibility of pleuroscopic cryobiopsy using a flexible bronchoscope.
Methods
We conducted a retrospective cohort study of consecutive adult patients with undiagnosed exudative pleural effusion despite thoracocentesis who underwent pleuroscopic cryobiopsy using a flexible bronchoscope at Selayang Hospital, Malaysia, between November 2023 and September 2025.
Results
Thirty patients underwent pleuroscopic cryobiopsy via a flexible bronchoscope. The diagnostic yield was 90.0% (95% confidence interval (CI): 73.5–97.9%), and malignancy was the most common diagnosis (56.7%), with lung adenocarcinoma being the most frequent. 88.9% of lung adenocarcinoma biopsy samples were sufficient for Epidermal Growth Factor Receptor (EGFR) mutation analysis. 30% of the specimens showed granulomatous inflammation, while 10% were non-diagnostic. Median cryoprobe activation time was 5 seconds (interquartile range (IQR) 3-5), procedure duration was 45 minutes (IQR 30 – 46), and biopsy size was 10 mm (IQR 8-16). Minor bleeding occurred in 23.3% (95% CI: 9.9–42.3%) of patients, and moderate bleeding in 6.7% (95% CI: 0.8–22.1%). No major bleeding events occurred. No significant associations were observed between procedural variables and clinical outcomes.
Conclusion
Pleural cryobiopsy performed via a flexible bronchoscope is an effective and feasible diagnostic modality for undiagnosed exudative pleural effusion, with a low bleeding risk, providing high diagnostic yield and adequacy for molecular testing.
Keywords
Pleural effusion; Cryobiopsy; Pleuroscopy; Flexible bronchoscope; Diagnostic yield; Malaysia
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