Transbronchial lung cryobiopsy for diffuse and localized peripheral pulmonary lesions: A retrospective review of our early experience

Background: Transbronchial lung cryobiopsy (TBLC) is an emerging technique for obtaining lung biopsy. This retrospective study aimed to evaluate the performance and safety of TBLC performed on diffuse peripheral pulmonary lesions (DPPL) and localized peripheral pulmonary lesions (LPPL). Methods: 58 patients underwent TBLC. They were divided into two groups (DPPL and LPPL) based on radiological findings. The patients’ demographic data, procedural details, complications, and radiological and pathologic diagnostic results were analyzed. Results: The overall diagnostic yield for TBLC was 72.4%. In the subgroup analysis, the diagnostic yield was 74.3% for DPPL and 69.6% for LPPL. For LPPL, the overall diagnostic yield was 87.5% and 12.5% for lesions with positive and negative bronchus signs, respectively (P = 0.01). In both groups, the success of TBLC was not influenced by the size, number, or location of the biopsy. Thirty-two (82%) patients had mild bleeding, while six (15.4%) had moderate bleeding. Pneumothorax occurred in four (6.9%) patients, with three patients requiring chest tube drainage. The mean duration of hospital stay was longer for patients who either bled or developed pneumothorax compared to those who did not (5.64 days vs. 3.47 days; P = 0.014) and (14.25 days vs. 4.24 days; P = 0.035) respectively. Conclusion: TBLC provided an acceptable diagnostic yield for DPPL and LPPL under fluoroscopy guidance without the use of ancillary devices such as radial endobronchial ultrasound or guide sheath. The safety profile of TBLC corresponded with a low incidence of pneumothorax and manageable bleeding complications with the routine use of an endobronchial balloon.