Application of endobronchial ultrasound-guided cryobiopsy for centrally located intrapulmonary lesions: A...

Endobronchial ultrasound-guided cryobiopsy (EBUS-cryo) enables the collection of high-quality specimens from lymphadenopathy. Expanding its application to intrapulmonary lesions may provide sufficient tissue quality and quantity for lung tumors. Therefore, we introduced EBUS-cryo through the tract created by EBUS-transbronchial needle aspiration (TBNA) for centrally located intrapulmonary lesions (CLILs) and evaluated its diagnostic utility, safety, and tissue sampling capability for CLILs.

Consecutive patients who underwent EBUS-cryo following EBUS-TBNA to diagnose CLILs at Osaka Metropolitan University Hospital between March 2023 and December 2024 were retrospectively analyzed. An expert pathologist assessed the quality and area of all tissue specimens, grading quality on a six-point scale (1-6), where scores of ≥ 5 defined as high quality. The tissue specimens' quality, area, and diagnostic performance of each biopsy technique were compared.

Of the 74 cases, 70 successful cases were included in the analysis. The diagnostic yields of EBUS-cryo and EBUS-TBNA were 95.7 % and 91.4 %, respectively (P = 0.51). Moderate bleeding occurred in 5.7 %; however, no severe complications were observed. The mean quality score and specimen area were higher with EBUS-cryo than with EBUS-TBNA (quality: 4.84 ± 1.31 vs. 2.27 ± 1.09, P < 0.001; area: 5.90 ± 3.06 mm² vs. 4.10 ± 3.51 mm², P < 0.001). The retrieval rate of high-quality specimens was higher with EBUS-cryo than with EBUS-TBNA (177/243, 72.8 % vs. 10/227, 4.4 %; P < 0.001).

Application of EBUS-cryo to CLILs offers high diagnostic utility, acceptable safety, and superior tissue sampling capability.