was converted to ultrasonographically guided pleural biopsy on the operating table, with establishment of the underlying diagnosis in 15 of 17 of these cases (88.2%). Of all patients undergoing day-case thoracoscopy, an underlying diagnosis was established in 196 of 202 patients (97%) (Fig 1). The vast majority (238 of 242) of day-case LAT procedures (98.3%) were performed without complications. Two cases were complicated by vasovagal reactions during or following the procedure, one case was complicated by late pleural infection resulting in readmission, and in one case, the patient experienced significant pain after the procedure and required opioid analgesia to achieve symptom control. Results are associated with the observation that in selected patients, LAT can be performed safely as a day- case procedure in a variety of centers with different characteristics, including size, population, and means of health-care service provision, models without compromising patient safety. The overall excellent diagnostic yield of the procedure (97%) suggests that LAT could be performed earlier in the diagnostic pathway, and in selected patients LAT could potentially be used as the first and only test needed to obtain a definitive diagnosis. In summary, our data set suggests that day-case LAT can be integrated successfully into pleural service provision across a range of health-care settings. This can offer a more convenient alternative to the traditional inpatient approach while maintaining an excellent diagnostic yield and safety profile. Ioannis Psallidas, PhD John P. Corcoran, BMBCh Oxford, England Janet Fallon, MBBS Taunton, England Oliver Bintcliffe, MBCHb Bristol, England Pasupathy Sivasothy, PhD Cambridge, England Nick Maskell, DM Bristol, England Fabien Maldonado, MD, FCCP Nashville, TN Justin Pepperell, MD Taunton, England Najib M. Rahman, DPhil Oxford, England AFFILIATIONS: Oxford Centre for Respiratory Medicine and Oxford Respiratory Trials (Drs Psallidas, Rahman, and Corcoran); Musgrove Park Hospital (Drs Fallon and Pepperell); Academic Respiratory Unit (Drs Bintcliffe and Maskell), University of Bristol; Department of Medicine (Dr Sivasothy), Cambridge University Hospital NHS Trust; Division of Allergy, Pulmonary and Critical Care Medicine (Dr Maldonado), Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine and Mayo Clinic. FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following: I. P. is the recipient of a REPSIRE2 European Respiratory Society Fellowship [RESPIRE2–2015–7160]. N. M. R. is funded by the National Institute Health Research (NIHR) Oxford Biomedical Research Centre. None declared (J. P. C., J. F., O. B., P. S., N. M., F. M., J. P.). CORRESPONDENCE TO: Ioannis Psallidas, PhD, Oxford University NHS Foundation Trust, Old Road, Churchill site, OX3 7LE, Oxford, UK; e-mail: ioannis.psallidas@ndm.ox.ac.uk Copyright Ó 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. DOI: http://dx.doi.org/10.1016/j.chest.2016.11.002 References 1. Hooper C, Lee YC, Maskell N, et al; Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65(suppl 2): ii4-ii17. 2. Colins Tr, Sahn SA. Thoracocentesis, clinical value, complications, technical problems and patient experience. Chest. 1987;91(6): 817-822. 3. Bhatnagar R, Corcoran JP, Maldonado F, et al. Advanced medical interventions in pleural disease. Eur Respir Rev. 2016;25(140):199-213. 4. Depew ZS, Wigle D, Mullon JJ, et al. Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center: a collaborative medical-surgical initiative. Chest. 2014;146(2):398-405. 5. Rahman NM, Ali NJ, Brown G, et al; British Thoracic Society Pleural Disease Guideline Group. Local anesthetic thoracoscopy: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65(suppl 2):ii54-ii60. Developments in Cryobiopsy for Interstitial Lung Disease May Be Cost Saving To the Editor: There has been increasing interest in transbronchial cryobiopsy for diagnosis in interstitial lung disease. As we highlighted in our systematic review and cost analysis, this has the potential to be cost saving in the setting of a payment by results system. 1 Recently, it has been demonstrated in a porcine model that a new sheath cryoprobe gives equivalent biopsy quality without the need for en bloc bronchoscope removal or an endotracheal tube. This has the potential to shorten procedure times by 34.8% and reduce bleeding by 81.8% and the incidence of pneumothorax by 66.7%. 2 With the shorter procedure time and no requirement for anesthetic airway support, this would augment the potential cost savings over surgical lung biopsy from our analysis from £210 to £934 per patient in the first year and 512 Correspondence [ 151#2 CHEST FEBRUARY 2017 ]