Late Breaking Abstract - CBCT-guided transbronchial cryobiopsy vs forceps biopsy for the diagnosis of ground glass opacity-predominant pulmonary lesions: a randomized control trial

<bold>Background:</bold> Conventional transbronchial forceps biopsy (FB) cannot obtain a satisfactory biopsy for ground glass opacity (GGO)-predominant pulmonary lesions. There are retrospective studies reported that the 1.1-mm cryoprobe can improve the diagnostic yield, but that has not been prospectively demonstrated. The study aimed to evaluate the efficacy and safety of transbronchial cryobiopsy (CB) vs FB for the diagnosis of GGO-predominant pulmonary lesions. <bold>Methods:</bold> In this multicenter prospective study, patients with GGO-predominant pulmonary lesions suspicious of malignant were enrolled and randomized to CB group or FB group with the guidance of CBCT, virtual navigation bronchoscopy, and endobronchial ultrasound. <bold>Results:</bold> A total of 89 patients were enrolled between September 2023 to May 2024, and 79 (CB group 42, FB group 37) were finally analyzed. Ten procedures were excluded due to tool-in-lesion was not obtained or pulmonary atelectasis confirmed by CBCT before sampling. The mean lesion size was 18.4 mm. The histological diagnostic yield was significantly higher in CB group than FB group (88.1% vs 40.5%, P <0.001). CB samples also had a larger total specimen area on microscopy (30.5 mm² vs 15.1 mm², P <0.001). Grade 2 bleeding was more frequent in the CB group than FB group (42.9% vs 13.5%, P=0.004). There was no significant difference in total procedure time and biopsy time. <bold>Conclusions:</bold> The diagnostic yield of CBCT-guided transbronchial CB for GGO-predominant pulmonary lesions was higher than FB, although with a higher risk of bleeding.