Cryobiopsy versus r-EBUS-guided forceps biopsy for diagnosis of peripheral pulmonary lesions: a retrospective study

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Background: The incidence of peripheral pulmonary lesions (PPLs) is rising, presenting diagnostic challenges. Radial endobronchial ultrasound (r-EBUS) guided forceps biopsy (TBFB) is a key diagnostic tool but has its limitations, including small samples size, crushing artefacts and the risk of pneumothorax. Transbronchial Cryobiopsy (TBLC) is a safe alternative that provides larger samples while preserving tissue architecture. Objective: To compare the diagnostic yield (DY) and complications of TBLC versus TBFB for the diagnosis of PPLs. Methods: This retrospective study included patients with PPLs who underwent TBFB or TBLC at Limoges University Hospital and Marie Lannelongue Hospital between January 2022 and April 2023. Patients with interstitial lung disease (ILD) were excluded. Results: A total of 287 patients were included, with 123 undergoing TBFB and 164 undergoing TBLC. The mean age was 68.3 ± 10.3 years. The DY of TBLC was significantly higher than TBFB (76.8% vs. 48%, p<0.001). In cases where ultrasound detection was unsuccessful, TBLC remained superior (80% vs. 16.7%, p=0.0065). Additionally, when there was no atelectasis behind the tumor, TBLC was more effective than TBFB (71.6% vs. 41.2%, p<0.0001). Mild to moderate bleeding occurred in 46.9% of TBLC cases compared to 21.2% in TBFB cases (p=0.0012), with no instances of severe bleeding. Pneumothorax was observed in one patient from the TBLC group and four patients from the TBFB group (p=0.1682). Conclusions: TBLC is a safe procedure that offers a higher DY than TBFB in r-EBUS peripheral navigation, though carries an increased risk of mild to moderate bleeding.

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