Diagnostic yield and safety of transbronchial cryobiopsy under fluoroscopy in peripheral pulmonary lesions

Abstract Background Flexible bronchoscopy is incapable of detecting focal radiographic opacities that extend beyond the visual segmental bronchi, which are defined as peripheral pulmonary lesions (PPLs). The purpose of this research was to evaluate the diagnostic yield and safety of transbronchial cryobiopsy (TBCB) under fluoroscopy in PPLs. Methods This prospective interventional cross sectional randomized controlled study involved 40 cases with PPLs at the Bronchoscopy Unit of Tanta Chest University Hospital. All cases underwent TBCB and were subdivided into two equal groups; the first 20 patients were in group I with application of the Fogarty catheter after the biopsy, and the next 20 patients were for group II with application of local (cold saline, adrenaline, cyclokapron, and dicynone) and the cryoprobe as a decongestant tool and evaluating their effect on patient outcome and biopsy quality. Results All the 40 patients (100%) underwent TBCB, as the mean no. and size of biopsies was (2.55 ± 0.71) and (6.10 ± 0.96) mm respectively. Reaching a definite diagnosis for all patients with a diagnostic yield (100%). while the safety was as the following, crush artifacts occurred in 7 patients (17.5%), bleeding occurred in 37 patients (92.5%) (represented with grade 1 bleeding by 75%, grade 2 bleeding by 15% and grade 3 bleeding by 2.5%) and pneumothorax occurred in 5 patients (12.5%), Hypoxia occurred in 9 patients (22.5%) and intensive care unit (ICU) admission was for 1 patient (2.5%). Conclusions This study confirms the high diagnostic yield and overallsafety of TBCB for peripheral pulmonary lesions, with a sampling technique that showed fewer complications. This supports the potential benefits of using this technique in improving biopsy quality and maintaining safety in the management of PPLs.