This is a prospective study to assess the yield of pleural biopsy obtained with the routine flexible thoracoscopic biopsy forceps versus that obtained with a flexible cryoprobe during semirigid thoracoscopy

Consecutive patients with exudative pleural effusions who are planned to undergo semirigid thoracoscopy will be enrolled in the study if they satisfy the inclusion criteria. They will be randomized in 1:1 ratio using a computer-generated randomization sequence to the following groups:

Group A: Four pleural biopsy specimens obtained using the flexible cryoprobe followed by eight pleural biopsy specimens obtained using the flexible thoracoscopic forceps OR Group B: The above two procedures will be performed in the reverse order The biopsies will be performed from different areas of the involved pleura with the two techniques. Thoracoscopy will be performed in the bronchoscopy suite on spontaneously breathing subjects (fasting for 8 h) under conscious sedation (using midazolam, pentazocine, and tramadol) observing complete aseptic precautions.

Inclusion Criteria:

• Age ≥12 years
• Semirigid thoracoscopy being performed for diagnosis of the pleural effusion

Exclusion Criteria:

• Age ≥80 years
• SpO2 <88% on room air
• Hemodynamic instability
• Myocardial infarction or unstable angina in the last 6 wk
• Lack of pleural space due to adhesions
• Uncorrected coagulopathy
• Failure to provide informed consent