Diagnostic Performance of Radial EBUS-Guided Cryobiopsy for Peripheral Lung Lesions: First Experience in Morocco

Accurate diagnosis of peripheral pulmonary lesions (PPLs) remains challenging. Conventional forceps biopsy frequently yields small samples compromised by crush artifact. Transbronchial cryobiopsy (TBCB) offers larger, better-preserved specimens. This study evaluated the diagnostic yield and safety of radial endobronchial ultrasound (r-EBUS)-guided TBCB using a 1.1-mm cryoprobe.

This prospective single-center study enrolled 73 consecutive patients with PPLs. Procedures were performed under general anesthesia using a laryngeal mask airway, a flexible bronchoscope, r-EBUS for localization, and a 1.1-mm cryoprobe inserted through a guide sheath. A prophylactic bronchial balloon blocker was employed for hemorrhage control. The primary outcome was diagnostic yield; secondary outcomes included bleeding severity and pneumothorax incidence.

Mean lesion diameter was 21 mm, with 79.5% of patients exhibiting a positive bronchus sign. A definitive histological diagnosis was established in 55 of 73 patients (75.3%). Malignancies accounted for 60.3% of diagnoses, whereas benign etiologies, including tuberculosis, represented 15.1%. Bleeding occurred in 19.2% of cases; all events were mild and managed with the balloon blocker. No severe hemorrhage was observed. Pneumothorax occurred in six patients (8.2%), with four requiring chest tube drainage.

r-EBUS-guided TBCB using a 1.1-mm cryoprobe is feasible and effective for diagnosing PPLs, with a diagnostic yield of 75.3%. Protocolized use of a balloon blocker effectively prevents severe hemorrhagic complications. Pneumothorax risk warrants vigilance, particularly in patients with infectious cavitary disease.