Comparative Clinical Impact of Transbronchial Cryobiopsy and Forceps Biopsy Utilizing Radial EBUS Guidance for the Diagnosis of Peripheral Pulmonary Lesions

Background: The prevalence of peripheral pulmonary lesions (PPLs) is increasing; however, their diagnosis remains challenging despite the availability of various modalities.Transbronchial cryobiopsy (TBCB) offers an additive benefit in diagnostic yield.Combining radial endobronchial ultrasound (R-EBUS)-guided transbronchial forceps biopsy (TBFB) with cryobiopsy may enhance tissue acquisition.Methods: This retrospective study reviewed 197 patients with pulmonary lesions who underwent bronchoscopy-guided biopsy between January 1, 2023, and December 31, 2023.Strict diagnostic yield and diagnostic accuracy were calculated according to the predefined definition, and the additive impact of cryobiopsy was further analyzed.Results: The cohort comprised 117 patients in the TBFB group and 80 in the TBCB group.The overall mean age was 68 years and 60% were male; baseline lesion characteristics were comparable across groups, with lesions <20 mm in 45% and 44% of the TBFB and TBCB groups, respectively, and a positive CT bronchus sign in 82% and 85%.Compared with TBFB alone, the TBCB group achieved a higher strict diagnostic yield (76.2% vs. 63.2%) and diagnostic accuracy (86.8% vs. 80.4%), respectively.Among the 33 patients in whom R-EBUS-guided TBFB was followed sequentially by cryobiopsy, the addition of cryobiopsy further increased diagnostic yield and accuracy by 21.6% and 13.5%, respectively.Procedure-related severe bleeding and severe hypoxia occurred in 2.5% and 1.3% of patients in the TBCB group, both significantly higher than the corresponding rates in the TBFB group (p < 0.05).Conclusion: R-EBUS-guided TBCB demonstrated efficacy for diagnosing PPLs, offering superior diagnostic yield and accuracy than conventional R-EBUS-guided transbronchial lung biopsy alone.