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Abstract Schwannomas are classified as neurogenic tumors and are the most frequent nerve sheath tumors in the paravertebral mediastinum. Recently, the addition of endobronchial ultrasound‐guided intranodal forceps biopsy (EBUS‐IFB) using standard‐sized biopsy forceps (SBFs) to endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) for metastatic lymph nodes in lung cancer patients reportedly improved the quality and quantity of the obtained specimens without significant complications. However, reports on the usefulness of this technique for benign diseases remain scarce. Here we report a case of schwannoma in the middle mediastinum, which was diagnosed by EBUS‐IFB using SBFs, despite inadequate specimens obtained via EBUS‐TBNA. An 80‐year‐old woman presented with dyspnea and a 5‐cm sized middle mediastinal tumor. EBUS‐TBNA and EBUS‐IFB using SBFs were performed for histological diagnosis. No complications were associated with the bronchoscopy procedure, and schwannoma was solely diagnosed using the EBUS‐IFB specimens. EBUS‐IFB using SBFs is potentially useful for diagnosing benign diseases, including schwannomas, which are often difficult to diagnose with EBUS‐TBNA.

Following the principles of image-enhanced endoscopy and using standardized endoscopic classifications, it is possible to predict the morphological diagnosis of colorectal neoplasms with high accuracy. The large size and uneven surface of lesion significantly complicates a thorough examination, and routine biopsy is still widely practiced, despite its drawbacks. This makes it necessary to compare the results of optical and forceps biopsy and determine the expediency of performing the latter for different types of colorectal laterally spreading tumors (LST). Aim. To compare the pit and vascular pattern, determined endoscopically, with histopathological findings in LST, with the calculation of the diagnostic accuracy of optical evaluation and forceps biopsy. To ascertain the relationship between lesion size, morphological type, and the presence of malignant changes. Materials and methods. 80 LST ≥20 mm were included in the study. Expert image-enhanced endoscopy with NBI and utilizing Paris, Kudo, JNET and Hiroshima classifications was employed for optical evaluation and stratification of lesions. Target forceps biopsy was obtained from areas showing the most progressive changes. The data from optical biopsy and the pathohistology of forceps biopsy specimens were compared with the results of the pathohistological findings of removed LST. Statistics were calculated in the Statistica 13. Results. Group 1 comprised 30 patients with non-granular type LST, while group 2 consisted of 50 patients with granular type LST. The median diameter was 20 mm (IQR, 20; 25) and 40 mm (IQR, 25; 50), adenocarcinoma loci were found in 10 % and 32 % in the first and second groups, respectively. Correlations between lesion localization and LST subtype were assessed, as well as between the presence of malignant changes and the size and morphological type of the lesions. Comparative indicators of sensitivity (80.0 % / 81.8 % in the first and 76.7 % / 80.0 % in the second group), diagnostic accuracy (93.3 % for both methods in the first and 84.0 % / 86.0 % in the second group), and also predictive values were revealed for optical evaluation / forceps biopsy, respectively. The specificity was identical and amounted to 100 % in the first and 95 % in the second group. In all cases, p < 0.01. Conclusions. Mixed type LST-G lesions occur more often in the rectum, whereas flat elevated LST-NG lesions – in the transverse colon. The presence of adenocarcinoma correlates with the morphological type of tubulovillous adenoma and the larger size of the tumor; larger LSTs are more frequently tubulovillous adenomas. Optical and forceps biopsies demonstrate higher accuracy for non-granular types of LST compared to granular types. Forceps biopsy does not confer any advantages over optical biopsy and is not recommended for routine use.

Abstract Background Endobronchial ultrasound‐guided (EBUS) transbronchial needle aspiration (TBNA) has significantly improved the diagnostic workup for intrathoracic lymphadenopathies. More recently, EBUS intranodal forceps biopsy (IFB) has been developed in an attempt to maximize diagnostic yield by providing additional tissue. In this study, we aimed to assess the improvement of diagnostic yield with EBUS‐TBNA combined with EBUS‐IFB, compared to EBUS‐TBNA alone. Methods Consecutive patients who had 19‐G EBUS‐TBNA and EBUS‐IFB from August 30, 2018, to September 28, 2021, were included. Four senior pathologists retrospectively analyzed, independently and blindly, first, only the EBUS‐TBNA samples (cell block), then, at least 1 month later, both samples from EBUS‐TBNA and from EBUS‐IFB together. Results Fifty patients were included in the study and 52 lymph nodes were analyzed. Diagnostic yield was 77% (40/52) for EBUS‐TBNA alone and 94% (49/52) when combined with EBUS‐IFB (p = 0.023). Malignancy was diagnosed with EBUS‐TBNA combined with EBUS‐IFB in 25/26 cases (96%), versus 22/26 (85%) with EBUS‐TBNA alone (p = 0.35); and 4/5 (80%) versus 2/5 (40%) for lymphoma specifically. Kappa interobserver agreement was 0.92 for EBUS‐IFB and 0.87 for EBUS‐TBNA alone. Nonmalignant condition was diagnosed with EBUS‐TBNA combined with EBUS‐IFB in 24/26 cases (92%), versus 18/26 (69%) for EBUS‐TBNA alone (p = 0.07). Conclusion The use of EBUS‐IFB combined with 19‐G EBUS‐TBNA improves the mediastinal lymph node diagnostic yield However the benefit appears to be mainly restricted to nonmalignant histology.

Introduction: Forceps Biopsy (FB) is usually used to obtain tissue in endobronchial lesions through a flexible bronchoscope. The mean diagnostic rate of bronchoscopic FB is 74% in central tumours. A limitation of FB is the small tissue size and the occurrence of crush artifacts. In contrast, Cryobiopsy (CB) provides larger samples without such artifacts, which are crucial for accurate histopathological diagnoses. Aim: To compare the efficacy and safety of CB with FB in endobronchial mass lesions suspected of lung cancer. Materials and Methods: A cross-sectional study was conducted on suspected endobronchial mass lesions with suspicion of malignancy from October 2015 to March 2017. About 35 patients fulfilling the inclusion criteria were enrolled, and five of these 35 patients were excluded as they were diagnosed with benign lesions. Among these 30 patients, a flexible biopsy was obtained first followed by CB using the same endobronchial cryobiopsy. Data were analysed in terms of tissue viability, mean tissue size, diagnostic yield, complications, and histological diagnosis. Parameters were compared using the Chi-square test (χ2 test) and Fisher’s exact test. Results: The mean age of the study participants was 58.33±10.12 years. The mean±SD size (diameter) of tissue obtained by CB (0.73±0.47 cm) was higher than that of FB (0.23±0.08 cm) (p-value

Background/Aims: The discrepancies between the diagnosis of preoperative endoscopic forceps biopsy (EFB) and endoscopic submucosal dissection (ESD) in patients with early gastric neoplasm (EGN) exist objectively. Among them, pathological upgrading directly influences the accuracy and appropriateness of clinical decisions. The aims of this study were to investigate the risk factors for the discrepancies, with a particular focus on pathological upgrading and to establish a prediction model for estimating the risk of pathological upgrading after EFB. Methods: We retrospectively collected the records of 978 patients who underwent ESD from December 1, 2017 to July 31, 2021 and who had a final histopathology determination of EGN. A nomogram to predict the risk of pathological upgrading was constructed after analyzing subgroup differences among the 901 lesions enrolled. Results: The ratio of pathological upgrading was 510 of 953 (53.5%). Clinical, laboratorial and endoscopic characteristics were analyzed using univariable and binary multivariable logistic regression analyses. A nomogram was constructed by including age, history of chronic atrophic gastritis, symptoms of digestive system, blood high density lipoprotein concentration, macroscopic type, pathological diagnosis of EFB, uneven surface, remarkable redness, and lesion size. The C-statistics were 0.804 (95% confidence interval, 0.774 to 0.834) and 0.748 (95% confidence interval, 0.664 to 0.832) in the training and validation set, respectively. We also built an online webserver based on the proposed nomogram for convenient clinical use. Conclusions: The clinical value of identifying the preoperative diagnosis of EGN lesions is limited when using EFB separately. We have developed a nomogram that can predict the probability of pathological upgrading with good calibration and discrimination value.

Benign and malignant mediastinal lesions are not infrequently encountered in clinical practice. Mediastinoscopy has long been considered the gold standard in evaluating mediastinal pathology. Since its introduction into clinical practice, endobronchial-ultrasonography-guided transbronchial fine needle aspiration (EBUS-TBNA) has replaced mediastinoscopy as the initial procedure of choice to evaluate mediastinal lesions and to stage lung cancer. Its diagnostic yield in benign mediastinal lesions and less common malignancies, however, has remained limited. This has led different proceduralists to investigate additional procedures to improve the diagnostic yield of EBUS-TBNA. In recent years, different published reports concluded that the addition of EBUS-guided intranodal forceps biopsy (IFB) and transbronchial cryobiopsy (TBCB) to EBUS-TBNA increases the diagnostic yield especially in benign mediastinal lesions and uncommon mediastinal malignancies. The purpose of this review is to describe how EBUS-IFB and EBUS-TBCB are performed, to compare their diagnostic yields, and to discuss their limitations and their potential complications. In addition, the review will conclude with a proposed algorithm on how to incorporate EBUS-IFB and EBUS-TBCB into clinical practice.

Background: Electromagnetic navigation bronchoscopy (ENB) is an advanced imaging-guided technique used to diagnose peripheral pulmonary lesions. However, the optimal strategy for selecting biopsy devices remains unclear., Research Question: Does the combination of needle aspiration and forceps biopsy improve diagnostic yield compared with that using a single device alone?, Study Design and Methods: We conducted a randomized crossover study during ENB performed under moderate sedation. This trial recruited participants with peripheral pulmonary lesions requiring biopsy who were eligible for elective ENB. ENB-guided needle aspiration and forceps biopsy were sequentially performed in a randomized order. The primary outcome was diagnostic yield, defined as the percentage of patients for whom the biopsy provided a specific diagnosis able to inform patient management. The diagnostic yield achieved by each biopsy modality individually and in combination was evaluated., Results: Between December 1, 2021, and November 13, 2023, 142 participants were enrolled and underwent the study procedures. Complete follow-up data were obtained for 140 participants. Diagnostic yield was 44.4% (63/142) for forceps biopsy, 51.4% (73/142) for needle aspiration (p=0.221 vs. forceps), and 66.9% (95/142) for the combination (p<0.001 vs. forceps alone, p<0.001 vs. needle alone). Sensitivities for malignancy were 58.3% (70/120) for needle aspiration and 47.5% (57/120) for forceps biopsy (p=0.074). The combination of the two modalities resulted in a significantly improved sensitivity of 71.7% (86/120) compared with either individual modality (p<0.001 vs. forceps alone and needle alone). Pneumothorax occurred in 3.5% (5/142) of patients, and 1.4% (2/142) developed pneumothorax requiring tube drainage., Interpretation: When performing ENB under moderate sedation, the combination of needle aspiration and forceps biopsy significantly improves the diagnostic yield and sensitivity for malignancy compared to each modality alone, with a favorable safety profile. These results indicate that a multimodal approach using needles and forceps is a valid diagnostic strategy for ENB., Clinical Trial Registration: NCT05110131., (Copyright © 2025. Published by Elsevier Inc.)

Background: Transcutaneous transhepatic endobiliary forceps biopsy is an accepted method for verification of extrahepatic cholangiocarcinoma, but its sensitivity ranges from zero to 94%. In the recent years, optical coherence tomography (OCT) has been actively used to diagnose malignancies. Aim: To assess diagnostic accuracy of the OCT-assisted intraductal forceps biopsy in patients with Klatskin tumor. Materials and methods: From 2013 to 2021, 161 patients with preliminary diagnosis of Klatskin tumor were seen in Russian Scientific Center of Radiology and Surgical Technologies named after Academician A.M. Granov. The retrospective study included 48 patients and 51 procedures of the forceps biopsy. In 14 (29%) patients of the main study group, the biopsy procedure was performed with OCT assistance, whereas the control group (34 patients, 71%) had their biopsies without the OCT. Results: All procedures were technically successful. In the main and in the control study groups, sensitivity was 92.3% versus 73.3% (p = 0.32) and specificity 100% versus 85.7% (p = 0.88), respectively. Malignant neoplasm of the biliary tract was found in 13 cases versus 23 in the control group, with the degree of the tumor differentiation being determined in 64.3% (n = 9), versus 48.7% (n = 18) (p = 0.89), respectively. There were no adverse events associated with OCT and biopsy sampling in the main study group. In the control group, 4/37 procedures (10.8%) were associated with hemobilia, which was successfully treated conservatively within 24 hours without any prolongation of the hospital stay. Conclusion: Our preliminary results indicate that antegrade endobiliary forceps biopsy is a safe and informative technique. The OCT navigation increases the sensitivity and specificity of the diagnosis. This allows for a personalized choice of chemotherapy. OCT is a promising technique for differential diagnosis of Klatskin tumor from benign biliary strictures. Further large-scale studies are required to introduce it into everyday practice.

Endobronchial ultrasound (EBUS) and transbronchial needle aspiration (TBNA) have changed the landscape of pulmonology. Mediastinal structures beyond the confines of airway walls are visualized in real-time with EBUS, leading to improved accuracy of tissue sampling and diagnostic yield. With the development of various needle sizes ranging from 25-G to 19-G, the sampling of lymph nodes is becoming easier and more commonplace. Yet, certain conditions such as sarcoidosis and lymphoma may still be difficult to diagnose via EBUS-TBNA. Furthermore, in the age of targeted therapy, there are more demands on EBUS-TBNA samples for molecular marker testing and next-generation sequencing. Here, we present a complementary methodology, EBUS-guided intranodal forceps biopsy (EBUS-IFB), for tissue acquisition that may help address these deficiencies. Specifically, we aim to propose indications, contraindications, outline approaches in performing IFB, and provide an overview of the data for this complementary technique.

Aim. To evaluate the safety and accuracy of percutaneous transhepatic biliary biopsy in patients with suspected Klatskin tumor.Materials and methods. Between 2013–2020, percutaneous transhepatic biliary drainage (PTBD) was performed in 52 patients with Klatskin tumor, complicated by obstructive jaundice. After successful PTBD, the diagnosis was verified by antegrade access. 74 procedures were performed: brush (n = 36; 48.6 %) or forceps biopsies (n = 38; 51.4 %).Results. There were no adverse events associated with a brush biopsy. Only grade I complications were after the forceps technique: 3 patients (7.9 %) developed hemobilia, which was corrected conservatively. Malignant lesions of the biliary tract were detected by forceps technique in 79.0 %, brush biopsy in 66.7 % (p >0,05). The degree of tumor differentiation was determined in 60.0 % (n = 18) vs 12.5 % (n = 3) (p < 0,01), respectively.Sensitivity and specificity of forceps biopsy were slightly higher than in brush: 82.4 % and 75.0 % vs 73.3 % and 66.7 % (p >0,05).Conclusions. Antegrade percutaneous transhepatic biliary biopsy is safe for both brush and forceps techniques. However, forceps biopsy has higher sensitivity and specificity in the diagnosis Klatskin tumor and better possibility of determining the degree of malignancy differentiation.

A 71-year-old man with follicular lymphoma of the right inguinal lymph node was referred to our hospital owing to mediastinal lymph node enlargement (left #12). The patient had a history of cyclosporine (CYS-A) and steroid therapy for fibrotic hypersensitivity pneumonitis. Endobronchial ultrasound-transbronchial aspiration and endobronchial ultrasound-guided intranodal forceps biopsy (EBUS-IFB) were performed under conscious sedation using midazolam and fentanyl. Histological examination of the tissue obtained by EBUS-IFB soley revealed follicular lymphoma., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Matsuoka et al.)

Background: Conventional Forceps biopsy is associated with smaller specimen sizes and more crushed artifacts. Recently, cryobiopsy has been suggested to be associated with higher diagnostic yield due to its ability to obtain larger biopsies with less crush artifacts when compared to conventional biopsy techniques. This study aimed for assessment of the diagnostic yield of cryobiopsy compared to the forceps biopsy for endobronchial lesions. Methods: In this cross sectional study, 48 patients with endobronchial lesions underwent bronchoscopic forceps biopsy and cryobiopsy, at the Chest Department, Faculty of Medicine, Zagazig University, and the specimens were sent for histopathological analysis. Results: Two methods showed statistically significant differences as regards the diagnostic yield as all the cryoprobe biopsies (100%) were diagnostic while only (81.3%) of forceps biopsies were diagnostic (P value = 0.002). Conclusions: Cryobiopsy yielded larger tissue specimens, resulting in a higher diagnostic yield and a lower prevalence of non-diagnostic results compared to forceps biopsy. [ABSTRACT FROM AUTHOR]

Endobronchial ultrasound (EBUS) guided mediastinal cryobiopsy, and intranodal forceps biopsy are newer modalities for sampling mediastinal lymph nodes. The data regarding the diagnostic yield of both modalities is scarce. Patients were recruited retrospectively from our existing database. Patients who had undergone both an EBUS guided mediastinal cryobiopsy and an intranodal forceps biopsy were enrolled in the study. The final diagnosis was made with a clinical-pathological-radiological assessment and clinico-radiological follow-up after one month. A total of 34 patients were enrolled in the study who had undergone both EBUS guided mediastinal cryobiopsy and intranodal forceps biopsy and had complete data available, including 1-month follow-up data. The sample adequacy rate of EBUS-transbronchial needle aspiration (EBUS-TBNA), EBUS-TBNA with mediastinal cryobiopsy, and EBUS-TBNA with intranodal forceps biopsy was 94.11%, 97.05%, and 94.11%, respectively (p=0.56). The diagnostic yield achieved in EBUS-TBNA, EBUS-TBNA with mediastinal cryobiopsy, and EBUS-TBNA with intranodal forceps biopsy was 73.52%, 82.35%, and 79.41%, respectively (p=0.38). No major complications were seen in any patient. To conclude, adding EBUS guided mediastinal cryobiopsy and intranodal forceps biopsy to EBUS-TBNA may not be superior to routine EBUS-TBNA.

Background and Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a diagnostic procedure with adequate performance; however, its ability to provide specimens of sufficient quality and quantity for treatment decision-making in advanced-stage lung cancer may be limited, primarily due to blood contamination. The use of a 0.96-mm miniforceps biopsy (MFB) permits true histological sampling, but the resulting small specimens are unsuitable for the intended applications. Therefore, we introduced a 1.9-mm standard-sized forceps biopsy (SFB) and compared its utility to that of MFB., Methods: We prospectively enrolled patients from three institutions who presented with hilar/mediastinal lymphadenopathy and suspected advanced-stage lung cancer, or those who were already diagnosed but required additional tissue specimens for biomarker analysis. Each patient underwent MFB followed by SFB three or four times through the tract created by TBNA using a 22-gauge needle on the same lymph node (LN). Two pathologists assessed the quality and size of each specimen using a virtual slide system, and diagnostic performance was compared between the MFB and SFB groups., Results: Among the 60 enrolled patients, 70.0% were diagnosed with adenocarcinoma. The most frequently targeted sites were the lower paratracheal LNs, followed by the interlobar LNs. The diagnostic yields of TBNA, MFB and SFB were 91.7%, 93.3% and 96.7%, respectively. The sampling rate of high-quality specimens was significantly higher in the SFB group. Moreover, the mean specimen size for SFB was three times larger than for MFB., Conclusion: SFB is useful for obtaining sufficient qualitative and quantitative specimens., (© 2024 Asian Pacific Society of Respirology.)

EBUS-TBNA is a well-established procedure for diagnosis of mediastinal lymphadenopathy replacing the need for mediastinoscopy. In certain diseases like lymphomas, the yield is reportedly 50%, sarcoidosis lymph nodes also give a yield of 80% with EBUS and at times, more material is needed for better characterization of malignancies. EBUS-intranodal forceps biopsy may be useful in these situations. In our series of seven cases, we describe a unique and safe technique of obtaining forceps biopsy from mediastinal lymph nodes under real-time endobronchial ultrasound guidance using a 19G EBUS-TBNA needle tract and thin biopsy forceps. Lymph node biopsy was able to give a conclusive diagnosis in 42% patients negative with TBNA, and was able to suggest a diagnosis in one case. No complications were seen. Thus, surgical biopsy can be avoided in nearly 50% of failed EBUS-FNAC cases.

Context Exudative pleural effusion is a diagnostic dilemma that includes many steps; one of them is obtaining a definite diagnosis through pleural biopsy. Cryoprobes are being increasingly used for obtaining larger specimens with fewer crush artifacts. However, the safety and feasibility of cryoprobe biopsy compared with standard forceps for pleural biopsy have not been fully assessed. Aims To evaluate the diagnostic value, size, and quality of the specimens obtained by flexible cryoprobe in comparison with those obtained by flexible forceps probe during medical thoracoscopy in patients with exudative pleural effusion and to assess the possible complications from the procedure. Settings and design This interventional prospective study was carried out at the endoscopy unit at Chest Department and Tuberculosis Assiut University Hospital. Patients and methods This study included 60 patients with undiagnosed exudative pleural effusion. Medical thoracoscopy was carried out for all the patients, and pleural biopsies were taken from the parietal pleura using a conventional rigid forceps probe and flexible cryoprobe in the same settings. Results Cryoprobe biopsy established a definite diagnosis in 55/60, with 91.6% diagnostic yield, whereas forceps biopsy had a definite diagnosis in 53/60, with 88.3% diagnostic yield. The size of cryoprobe biopsy was significantly larger in comparison with the forceps biopsy (26.56 ± 22.16 vs. 17.38 ± 12.08 mm2; P

Dear Editor, The recent study by Madan et al. provides valuable information on the utility of intranodal cryobiopsy or forceps to endobronchial ultrasound - transbronchial needle aspiration during sampling of mediastinal lymph nodes...

BackgroundPleural 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.MethodsFor 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.ResultsOf 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.ConclusionsCompared 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.

BackgroundCryobiopsy has emerged as a novel alternative to conventional forceps biopsy for the diagnosis of interstitial lung diseases (ILDs), lung tumors, and peripheral pulmonary lesions (PPLs). This study aims to compare cryobiopsy and forceps biopsy for the diagnosis of these lung pathologies with respect to efficacy and safety by performing a meta-analysis of updated evidence.MethodsA number of databases, such as PubMed, Embase, Web of Science, the Cochrane Library, OVID, CNKI, and Wanfang database, were searched for eligible studies. Randomized and non-randomized comparative studies investigating the efficacy and safety of cryobiopsy vs. forceps biopsy for lung pathologies were included. Pooled results were calculated as an odds ratio (OR) or standardized mean difference (SMD) with 95% CI.ResultsA total of 39 studies, such as 9 RCTs with 3,586 biopsies (1,759 cryobiopsies and 1,827 flexible forceps biopsies) were analyzed. Cryobiopsy was associated with a significant increase in the diagnostic rates of ILDs (OR, 4.29; 95% CI, 1.85–9.93; p < 0.01), lung tumors (OR, 3.58; 95% CI, 2.60–4.93; p < 0.01), and PPLs (OR, 1.70; 95% CI, 1.23–2.34; p < 0.01). Cryobiopsy yielded significantly larger specimens compared with flexible forceps biopsy (SMD, 3.06; 95% CI, 2.37–3.74; p < 0.01). The cryobiopsy group had a significantly higher (moderate to severe) bleeding risk than the forceps group (OR, 2.17; 95% CI, 1.48–3.19; p < 0.01). No significant difference was observed in the incidence of pneumothorax between the groups (OR, 0.90; 95% CI, 0.44–1.85; p = 0.78).ConclusionOur results demonstrate that cryobiopsy is a safe and efficacious alternative to conventional forceps biopsy.

Objective: This study aimed to evaluate the diagnostic performance and procedural characteristics of fluoroscopy-guided percutaneous transthoracic pleural forceps biopsy (PTPFB) in patients with exudative pleural effusion., Materials and Methods: Patients with exudative pleural effusion who underwent PTPFB between May 1, 2014, and February 28, 2023, were included in this retrospective study. The interval between percutaneous catheter drainage (PCD) and PTPFB, number of biopsies, procedural time, and procedure-related complications were evaluated. The sensitivity, specificity, and accuracy of diagnosing malignancy were computed for pleural cytology using PCD drainage, PTPFB, and combined PTPFB and pleural cytology., Results: Seventy-one patients, comprising 50 male and 21 female (mean age, 69.5 ± 15.3 years), were included in this study. The final diagnoses were benign lesions in 48 patients (67.6%) and malignant in 23 patients (32.4%). The overall interval between PCD and biopsy was 2.4 ± 3.7 days. The interval between PCD and biopsy in the group that underwent delayed PTPFB was 5.2 ± 3.9 days. The mean number of biopsies was 4.5 ± 1.3. The mean procedural time was 4.4 ± 2.1 minutes. Minor bleeding complications were reported in one patient (1.4%). The sensitivity, specificity, and accuracy for pleural cytology, PTPFB, and combined PTPFB and pleural cytology were 47.8% (11/23), 100% (48/48), and 83.1% (59/71), respectively; 65.2% (15/23), 100% (48/48), and 88.7% (63/71), respectively; and 78.3% (18/23), 100% (48/48), and 93.0% (66/71), respectively. The sensitivity and accuracy of cytology combined with PTPFB were significantly higher than those of cytological testing alone ( P = 0.008 and 0.001, respectively)., Conclusion: Fluoroscopy-guided PTPFB is an accurate and safe diagnostic technique for patients with exudative pleural effusion, with acceptable diagnostic performance, low complication rates, and reasonable procedural times., Competing Interests: The authors have no potential conflicts of interest to disclose., (Copyright © 2024 The Korean Society of Radiology.)