Outcomes of radial probe endobronchial ultrasound-guided transbronchial lung cryobiopsy using guide sheath and the...

The need to obtain high-quality samples from lung nodule suspected malignancy is continuing to rise. This study aimed to evaluate the diagnostic yield of radial probe endobronchial ultrasound-guided transbronchial lung cryobiopsy (RP-EBUS-TBLC) using guide sheath (GS) for lung lesions suspected of malignancy on computed tomography (CT).

This retrospective observational study included patients who underwent RP-EBUS-TBLC using GS between January 2023 and April 2025 in South Korea. We introduced Dohyun's method (a target-fixing technique) used to overcome the respiratory gating of the target during semi-real-time biopsy. After identifying the target lesion, the bronchoscope was inserted and fixed within the segment; the position was maintained while RP-EBUS was withdrawn, and the lesion stability during respiration was confirmed.

The final inclusion of 120 patients was analyzed. After the exclusion of patients with an indeterminate diagnosis, the final diagnostic yield was 94.8% (90.8% to 95.0% considering indeterminate diagnosis). The sensitivity and specificity were 93.7% and 100.0%, respectively. Pneumothorax occurred in 5.0% (6/120) of patients. Grade 3 or higher bleeding was observed in two patients, and a Fogarty balloon catheter was preemptively used in five patients at the operator's discretion. In the multivariate logistic regression, the CT-bronchus sign emerged as the only significant factor associated with pathological confirmation. However, lesion size, eccentricity, and lower lung distribution were not significantly associated.

RP-EBUS-TBLC using GS demonstrated high diagnostic yield and acceptable safety for the diagnosis of lung lesions. Dohyun's method may facilitate continuous targeting of lesions during semi-real-time biopsy, particularly in cases where respiratory motion and non-within-RP-EBUS target lesions present challenges.