Robotic-Assisted Bronchoscopic Lung Cryobiopsy Is Associated With Higher Diagnostic Yield in Diffuse Parenchymal Lung Disease: A Multicenter Retrospective Cohort Study

Abstract Background Transbronchial lung cryobiopsy (TBLC) is increasingly used to obtain tissue for the diagnosis of diffuse parenchymal lung disease (DPLD). However, diagnostic performance and complication rates vary with procedural technique and institutional experience. Robotic-assisted bronchoscopy (RAB) with cone-beam computed tomography (CBCT) may improve target localization and parenchymal sampling. Methods We conducted a multicenter retrospective cohort study of 65 adults who underwent TBLC for suspected DPLD at three Mayo Clinic sites between January 2025 and June 2026. Patients underwent FB-TBLC with a 1.1-mm cryoprobe ( n = 26), FB-TBLC with a 1.7-mm cryoprobe ( n = 19), or RAB-TBLC with a 1.1-mm cryoprobe ( n = 20). We compared specific histopathologic diagnostic yield and procedure-related complications among biopsy approaches. Results Specific histopathologic diagnostic yield was 61.5% with FB-TBLC using a 1.1-mm cryoprobe, 73.7% with FB-TBLC using a 1.7-mm cryoprobe, and 95.0% with RAB-TBLC ( P = 0.032). After adjustment for radiographic fibrosis and maximum biopsy dimension, RAB-TBLC remained associated with higher diagnostic yield than FB-TBLC using a 1.1-mm cryoprobe (adjusted OR, 11.15; 95% CI, 1.76–219.95). Diagnostic yield did not differ between the two FB-TBLC groups. Complication rates were 34.6%, 42.1%, and 10.0%, respectively ( P = 0.065). Conclusion RAB-TBLC using a 1.1-mm cryoprobe was associated with a higher specific histopathologic diagnostic yield than FB-TBLC, without a detectable increase in procedure-related complications. Prospective studies are needed to validate these findings and determine which components of the RAB sampling strategy contribute to diagnostic performance.