Clinical applications of cryobiopsy in the diagnosis of thoracic malignancies: a comprehensive review

Accurate histopathological and molecular characterization of lung cancer is essential for optimal treatment selection in the era of precision medicine. While conventional biopsy techniques are widely available and safe, they often yield small tissue samples with crush artifacts that may be insufficient for comprehensive molecular testing. Cryobiopsy has emerged as a promising diagnostic technique that addresses these limitations. For endobronchial and peripheral pulmonary lesions, cryobiopsy demonstrates superior diagnostic yields compared to conventional forceps biopsy, with enhanced capability for molecular diagnostics and programmed death-ligand 1 assessment. Endobronchial ultrasound (EBUS)-guided mediastinal cryobiopsy shows particular promise for lymph node sampling, achieving higher diagnostic yields than EBUS-guided transbronchial needle aspiration, especially for lymphoma and metastatic disease. Moreover, thoracoscopic cryobiopsy provides larger pleural specimens with preserved architecture, improving diagnosis of challenging cases including malignant mesothelioma. The safety profile remains favorable across all applications, with bleeding as the primary complication that is typically manageable with standard techniques. Cryobiopsy represents a significant advancement in thoracic oncology diagnostics, providing high-quality tissue specimens essential for contemporary cancer management.