الفهرس 
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Abstract
This prospective interventional study was conducted at Assuit University Hospital, Chest Department, Endoscopy unit during the period from October 2018 to October 2021.
Sixty patients with undiagnosed exudative pleural effusion were enrolled in this study who were subjected to careful history taking, clinical examination and routine laboratory investigations (including complete blood picture, coagulation profile, liver, and kidney function tests).
Pleural fluid study and radiological evaluation (including CXR, CT chest and chest ultrasound) were done. ECOG score was carried out to apply the inclusion criteria for the study.
The whole studied group had diagnostic medical thoracoscopy using rigid thoracoscopy (Karl Storz Heine optical, Tübingen Germany) with the single-port-of-entry technique under local anesthesia and conscious sedation using midazolam (2 mg) or pethidine (50 mg). Pleural biopsy was performed using the conventional forceps biopsy and cryoprobe in the same sitting.
According to the present study, the mean age of the studied group was 55.51 years with a range between 26 and 88 years old. The majority (63.3%) of enrolled patients were males. Twenty-nine (48.3%) patients were non-smokers, while 11(18.3 %) and 20(33.3%) patients were current and ex-smokers respectively.
Radiological evaluation revealed that collapsed lung was the most common finding in CT scan (65%). Chest ultrasound was performed to all studied patients and revealed that 39 patients (65%) had echogenic effusion while 21(35%) had anechoic effusion.
Nineteen patients had pleural nodules, collapsed lung was found in 38 patients (63.3%). Three patients had bilateral pleural effusions.
During gross thoracoscopic examination, pleural nodules was the most prevalent finding in malignant patients with 76.6%
Biopsies were taken using a forceps probe and cryoprobe and a comparison was made between the two types of biopsies regarding the diagnostic yield, the number, surface area, depth, and quality of biopsy using the Mair score.
In this study, cryoprobe biopsy established a definite diagnosis in (55/60) with 91.6% diagnostic yield while forceps biopsy had a definite diagnosis in (53/60) with 88.3% diagnostic yield.
Regarding the number of biopsies, it was found that cryoprobe biopsy had a significantly fewer number of biopsies (3.30± 0.74 vs 5.05 ± 0.81; p< 0.001) in comparison to forceps biopsies to establish a definite diagnosis.
The size of cryoprobe biopsy was significantly larger (26.56 ± 22.16 vs 17.38 ± 12.08 (mm2); p< 0.001) in comparison to forceps biopsy. the depth of pleural biopsy was evaluated by the presence of extrapleural fat cells which were significantly higher in cryoprobe biopsy (21 (35%) vs. 11 (18.3%); p= 0.03) in comparison to forceps biopsy. There were no significant complications or procedure-related deaths.
Regarding histopathological examination, the most prevalent diagnoses in malignant pleural effusion was metastatic carcinomas followed by mesothelioma (20%) and metastatic small cell carcinoma (5%).
Caseating granuloma was detected in (8.3%), chronic non-specific inflammation and necrotic tissue were reported in (5%) for each.
It was found that cryoprobe biopsy was superior to forceps biopsy in size, depth, and diagnostic yield but with similar biopsy quality.
Conclusion:
According to the present study, it was found that cryoprobe biopsy is a possible safe alternative to conventional forceps probe biopsy in the diagnosis of exudative pleural effusion with a larger, deeper and fewer number of biopsies. It was also found that CPB had a better diagnostic yield, sensitivity, and accuracy.
Limitation of the study:
Comparison between the two types of procedures regarding the complications can’t be established as both types of biopsies were carried out in the same patient.