OPA10 A RETROSPECTIVE STUDY ON THE DIAGNOSTIC EFFICACY OF CRYOBIOPSY IN PLEUROSCOPY USING FLEXIBLE BRONCHOSCOPE – A SINGLE TERTIARY CENTER EXPERIENCE

Wan Jen Lye, Thamayanthy Murugesu, Syahrinnaquiah Samsuddin, Shivaanand Letcheminan, Noor Izyani Zakaria
Hospital Selayang, Selangor, Malaysia
Hospital Kuala Kubu Bharu, Selangor, Malaysia

Introduction
Diagnosing exudative pleural effusion remains challenging, especially in regions with high tuberculosis prevalence like Malaysia. While pleuroscopy improves diagnostic yield than thoracocentesis and closed pleural biopsy, conventional forceps biopsy via rigid thoracoscopy can be limited due to cost and accessibility. Cryobiopsy offers larger and better-preserved samples and has shown good outcome in various thoracic procedures however not widely studied in pleural disease using a flexible bronchoscope.

Objectives
This study aimed to evaluate the efficacy, safety, and feasibility of pleuroscopic cryobiopsy using flexible bronchoscope in patients with undiagnosed exudative pleural effusion at a Malaysian tertiary center.

Methodology
A retrospective cohort study was conducted on 26 patients who underwent pleuroscopic cryobiopsy with a flexible bronchoscope from November 2023 to June 2025. Demographic, procedural, and histopathological data were collected and analysed.

Results
Among 26 patients (61.5% male), mean age was 60.31 ± 10.92 years. Right-sided effusion was predominant (61.5%). Mean cryoprobe activation time was 5.65 ± 2.53 seconds. Mean sample size was 12.54 ± 6.41 mm, and mean procedure time was 40.85 ± 12.77 minutes. Diagnostic yield was 88.4% including malignancies (53.8%) and non-malignancy (34.6%). Of nine adenocarcinoma cases sent for EGFR testing, 88.9% were adequate for testing. Complications included minor bleeding in 19.2% and moderate bleeding requiring argon plasma coagulation in 7.7%. No major bleeding or pneumothorax was observed. No significant correlation was found between activation time, sample size, and complication or diagnostic yield.

Conclusions
Pleuroscopic cryobiopsy using a flexible bronchoscope is feasible, safe, and effective. It provides adequate tissue for histopathological and molecular analysis, making it a valuable option in diagnosing exudative pleural effusions, particularly in resource-limited settings.