Transbronchial cryobiopsy for peripheral pulmonary lesions using ultrathin bronchoscopy: a narrative review

With the rising detection of peripheral pulmonary lesions (PPLs) and ground-glass opacities (GGOs) owing to widespread lung cancer screening, obtaining high-quality tissue for next-generation sequencing (NGS) has become critical. Conventional forceps biopsy often yields insufficient samples with crush artefacts, whereas ultrathin bronchoscopy (UTB) provides access to the peripheral airways. This narrative review aimed to evaluate the current evidence on the diagnostic utility, safety, and specimen quality of transbronchial cryobiopsy (TBLC) using a 1.1-mm cryoprobe in conjunction with UTB.

We conducted a comprehensive literature search for articles published between January 1, 2019 and October 31, 2025 using PubMed. We prioritized prospective and retrospective studies as well as case series investigating the clinical utility and safety of the 1.1-mm cryoprobe for PPLs. Single case reports were excluded.

The 1.1-mm cryoprobe exhibited superior flexibility, allowing access to the distal airways without compromising UTB performance. When integrated with advanced guidance technologies, such as radial endobronchial ultrasound (rEBUS), cone-beam computed tomography (CBCT), and robot-assisted bronchoscopy, cryobiopsy attained superior diagnostic yields compared with forceps biopsy. This advantage was particularly pronounced for GGO-predominant lesions and lesions identified as "adjacent to" on rEBUS, where forceps biopsy frequently fails. Crucially, cryobiopsy retrieved large, crush-free, en bloc tissue samples and preserved the histological architecture, significantly enhancing the success rates of programmed death-ligand 1 (PD-L1) evaluation and NGS. Regarding safety, while hemorrhage is a recognized complication, it is effectively managed using standardized protocols, such as the two-scope method or prophylactic balloon occlusion. Pneumothorax rates were comparable to those of conventional methods.

UTB-guided cryobiopsy represents a paradigm shift in diagnostic bronchoscopy, successfully balancing high diagnostic performance with acceptable safety. Overcoming the limitations of conventional sampling is essential in the era of precision medicine. Ongoing multicenter randomized controlled trials (RCTs) are expected to further cement the position of UTB-guided cryobiopsy as a standard-of-care modality.