Advancing Transbronchial Lung Cryobiopsy in Interstitial Lung Disease with Adjunctive Tools and Smaller Cryoprobes

Transbronchial lung cryobiopsy (TBLC) is increasingly used as a minimally invasive approach for tissue acquisition in the evaluation of interstitial lung disease (ILD), serving as an alternative to surgical lung biopsy (SLB) within multidisciplinary diagnostic pathways. Despite its growing adoption, variability in diagnostic yield and complication rates highlight the importance of procedural technique, probe selection, and freezing parameters. This narrative review summarizes the current landscape of TBLC, with emphasis on factors that influence diagnostic performance and safety, including procedural considerations involving endobronchial balloon blockade (EBB), radial probe endobronchial ultrasound (RP-EBUS), and cone-beam computed tomography (CBCT) for biopsy localization and airway management. Much of the existing experience is based on conventional cryoprobes, including 2.4 mm and 1.9 mm devices, typically used with freezing times of several seconds. While these approaches have defined the current role of TBLC in ILD, outcomes remain variable across centers, prompting continued refinement of procedural strategies to improve consistency. More recently, attention has expanded to include a broader range of smaller cryoprobe sizes—1.7 mm and 1.1 mm. Overall, this review provides a framework for understanding contemporary TBLC practice and highlights key areas where further study is needed to better define optimal technique and improve consistency in clinical outcomes.