Diagnostic Yield and Molecular Testing Adequacy of Transbronchial Cryoprobe Biopsy Versus Needle Aspiration in Robotic Bronchoscopy

BACKGROUND: In the AQuIRE trial, most cases (83.6%) did not involve transbronchial needle aspiration (TBNA), often underutilized due to challenges in accessing peripheral pulmonary lesions (PPLs). Advances in robotic bronchoscopy with shape-sensing technology (ssRAB) have mitigated these challenges, but the optimal number of needle and cryoprobe passes for reliable diagnosis remains undefined. METHODS: This retrospective study compares the diagnostic yield (DY) of TBNA and transbronchial cryoprobe biopsy (TBCB) and their adequacy for molecular testing in PPLs. We performed a retrospective analysis of 166 patients who underwent ssRAB with both TBNA and TBCB from May to August 2024. Fisher exact tests and McNemar χ2 tests were used to compare prevalence differences in DY and molecular testing adequacy between discordant cases. Odds ratios (OR) and 95% CIs of associations between the number of passes and diagnostic yield and rates of obtaining adequate samples for molecular testing were obtained using generalized linear mixed models (GLMMs) with a logit link. RESULTS: TBCB demonstrated a higher diagnostic rate than TBNA (89% vs. 80%, OR=2.04, 95% CI=1.06-4.03; P=0.032), as well as better rates of obtaining samples adequate for molecular testing (60% vs. 20%, OR=5.94, 95% CI=2.31-16.38, P<0.001). TBCB provided diagnostic yields in 55% (χ2=9.33, P=0.002) of cases where TBNA failed to provide a diagnosis and was able to obtain adequate samples for molecular testing in 42% (χ2=15.06, P<0.001) of cases where TBNA was unable to. CONCLUSION: TBCB suggests a higher diagnostic yield and higher cellular adequacy for molecular testing compared with TBNA, underscoring its potential value as a reliable and versatile diagnostic tool in PPLs.