Comparison of complications between transbronchial lung biopsy using small forceps and cryoprobes during radial probe endobronchial ultrasound for peripheral lung lesions in a fluoroscopy-free environment

Radial probe endobronchial ultrasound-guided transbronchial lung biopsy with small forceps (RP-EBUS-TBLB) is commonly used to diagnose peripheral lung lesions (PLLs). TBLB using a cryoprobe (CryoTBLB) also has recently become widely performed in many institutions. Fluoroscopic guidance may improve diagnostic accuracy but is associated with biohazard risks. There have been no reports comparing the incidence of complications between RP-EBUS-TBLB and RP-EBUS-CryoTBLB for PLLs without fluoroscopic guidance. This study aimed to compare the rate of complications between RP-EBUS-TBLB and RP-EBUS-CryoTBLB for PLLs without fluoroscopic guidance. We also compared the diagnostic yields of these two procedures. A total of 218 subjects were included from the two referral hospitals in South Korea. Subjects were divided into two groups: RP-EBUS-TBLB (n=139) and RB-EBUS-CryoTBLB (n=79). The cryoprobe used in the procedure was a single-use, flexible cryoprobe with an outer diameter of 1.1 mm (ERBE, Tübingen, Germany). The baseline characteristics of the subjects and target lesions were similar in both groups. There was no significant difference in diagnostic yield between the two groups. However, a statistically significant difference was observed in the overall complication rates (12.9% vs. 2.5%, p=0.010). The incidence of pneumothorax was significantly higher in the RB-EBUS-TBLB group (7.9% vs 1.3%, p=0.039). No significant difference was observed in the incidence of severe bleeding between the two groups, and there were no cases of severe bleeding in the RP-EBUS-CryoTBLB group. This study suggests that the use of CryoTBLB may reduce the risk of complications, particularly pneumothorax, during RP-EBUS for PLLs in a fluoroscopy-free environment.