Dual-Wield: An Observational Study of Utilization and Outcomes of Cryobiopsy and Intraoperative CT scan During Navigational Bronchoscopy

Abstract Background Pulmonary nodules are common incidental imaging findings, and distinguishing malignant from benign etiologies frequently requires invasive sampling. CT-guided transthoracic needle biopsy offers high yield but carries pneumothorax rates of 15–45% and precludes concurrent mediastinal staging. Shape-sensing navigational bronchoscopy, intraprocedural cone-beam CT (CBCT), and transbronchial cryobiopsy have each independently improved bronchoscopy performance, but integration of all three into one workflow remains poorly characterized. We describe real-world utilization and outcomes of these modalities at a large volume community tertiary care center. Research Question What is the real-world utilization, diagnostic performance, and complication rate of navigational bronchoscopy for lung nodule sampling with the addition of CBCT and cryobiopsy? Study Design and Methods We conducted a retrospective cohort study of navigational bronchoscopy procedures performed at a single community tertiary care center between January 1, 2024, and January 1, 2026. Two physician investigators independently abstracted procedure reports, imaging, and pathology from the electronic health record, recording cryobiopsy use, CBCT use, target nodule size, pathology, and complications. Diagnostic yield was determined using the strict ATS/ACCP consensus definition. Results Among 199 navigational bronchoscopy procedures, 229 lesions were sampled. Mean nodule size was 22.4 ± 17.7 mm overall, smallest with cryobiopsy plus CBCT (17.4 ± 13.7 mm) and largest with no adjunctive modality (29.8 ± 20.3 mm). Overall diagnostic yield was 78.0%: 83.9% with cryobiopsy plus CBCT, 75.0% cryobiopsy alone, 70.4% CBCT alone, and 73.2% no adjunctive modality. The complication rate was 3.5% (7/199). Diagnostic yield trended higher in cases with both cryobiopsy and CBCT. Conclusion Integrating navigational bronchoscopy with CBCT and cryobiopsy achieved the highest diagnostic yield while sampling the smallest nodules with an acceptable safety profile. Prospective randomized studies are warranted to define the independent contribution of each adjunct and to detect any true incremental harm.