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. 2022 Apr 11:9:847146.
doi: 10.3389/fmed.2022.847146. eCollection 2022.

Efficacy and Safety of Pleural Cryobiopsy vs. Forceps Biopsy for Evaluation of Undiagnosed Pleural Effusion: A Systematic Review and Meta-Analysis

Mohan Giri  1 , Haiyun Dai  1 , Shuliang Guo  1 , Yishi Li  1 , Lin He  2 , Rongjuan Zhuang  1
Affiliations

Efficacy and Safety of Pleural Cryobiopsy vs. Forceps Biopsy for Evaluation of Undiagnosed Pleural Effusion: A Systematic Review and Meta-Analysis

Mohan Giri et al. Front Med (Lausanne). .

Abstract

Background: Pleural cryobiopsy is a novel technique for the diagnosis of pleural pathologies. However, the safety and feasibility of this modality compared to standard forceps for pleural biopsy has not been fully elucidated. This systematic review and meta-analysis aims to establish the efficacy and safety of cryobiopsy for evaluation of undiagnosed pleural effusion.

Methods: For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and Web of science databases up to December 16, 2021 to identify relevant articles. We included randomized controlled trials, cohort studies, retrospectives studies and case series that compared pleural cryobiopsy and forceps biopsy. A qualitative assessment was performed using the QUADAS-2 tool.

Results: Of the 365 articles identified by our search, 15 studies were eligible for inclusion. The specimen sizes obtained with cryobiopsy were significantly larger compared with forceps biopsy (Standard mean difference 1.16; 95 % CI: 0.51-1.82; P < 0.01). Furthermore, the cryobiopsy tissue specimens were deeper (OR 2.68; 95 % CI: 1.39-5.16; P < 0.01) and qualitatively better with less crush artifacts (OR 0.06; 95 % CI: 0.01-0.26; P < 0.01). There was no significant difference in diagnostic yield (OR 1.32; 95 % CI: 0.79-2.21; P = 0.29) and mild to moderate bleeding events (OR 1.21; 95 % CI: 0.64-2.29; P = 0.57) between pleural cryobiopsy and forceps biopsy. No publication bias was observed among these studies.

Conclusions: Compared to flexible forceps biopsy pleural cryobiopsy obtained larger and deeper tissue specimens with less crush artifacts but does not show superiority for diagnostic yield. Further studies are still needed to verify these findings.

Keywords: forceps biopsy; meta-analysis; pleural cryobiopsy; pleural effusion; pleuroscopy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA Flow chart of study selection process.
Figure 2
Figure 2
Forest plot comparing specimen size of pleural cryobiopsy vs. forceps biopsy.
Figure 3
Figure 3
Forest plot comparing diagnostic yield of pleural cryobiopsy vs. forceps biopsy.
Figure 4
Figure 4
Forest plot of crush artifacts for pleural cryobiopsy vs. forceps biopsy.
See this image and copyright information in PMC

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