Comparative study of transbronchial cryobiopsy and transbronchial biopsy for diagnostic yield in peripheral pulmonary lesions

Background Transbronchial cryobiopsy (TBCB) is a minimally invasive technique that yields larger specimens than conventional transbronchial forceps biopsies (TBFB) and demonstrates superior diagnostic rates for interstitial lung diseases. However, the efficacy of TBCB compared to TBFB in evaluating peripheral pulmonary lesions (PPLs) is not well established. This study aims to examine the diagnostic performance of TBCB relative to TBFB in PPLs.Material and methods Between May 2021 and December 2023, patients with PPLs were enrolled and underwent TBFB followed by TBCB. These procedures were performed either in a hybrid operating room (HOR) or a standard bronchoscopy room without fluoroscopy. The study compared histopathology diagnostic yield between the two methods.Results The study included 84 patients. The median lesion size was 37 mm (interquartile range: 26, 54), with 16 lesions (19.0%) measuring less than 2.0 cm. Among the participants, 44 (52.4%) were diagnosed with lung cancer, and 28 (33.3%) had infectious diseases. TBCB yielded significantly larger tissue samples [60 mm3 (range: 30, 144) vs. 4 mm3 (range: 2, 6), p < 0.001] and higher diagnostic yields (94.0% vs. 77.1%, p < 0.001) than TBFB. The higher diagnostic yield for TBCB were consistent in both the bronchoscopic room (97.2% vs. 77.8%, p = 0.008) and HOR (91.5% vs. 76.6%, p = 0.033). The incidence of ≥ grade 3 bleeding was 7.1%.Conclusion TBCB significantly improves the diagnostic yield for PPLs, irrespective of fluoroscopic guidance, and is effective for both malignant and benign lesions. Furthermore, it is associated with minimal complications, affirming its safety and efficacy as a diagnostic procedure.HighlightsTBCB consistently provided a higher pathological yield compared to TBFB, independent of lesion size, use of fluoroscopy, or the nature of the pathology (benign or malignant)TBCB yielded larger tissue sample and had high successful rates for NGS testing.Combination of an ultrathin bronchoscope, augmented fluoroscopy, ROSE, and TBCB can lead to high diagnostic yields.