The Application Value and Safety of Ultrafine Bronchoscopy Combined with Frozen Lung Biopsy in the Diagnosis of Peripheral Pulmonary Nodules

Summary

This study aims to evaluate the diagnostic yield, specimen quality, and safety of ultrathin bronchoscopy-guided transbronchial cryobiopsy in diagnosing peripheral pulmonary nodules, compared with conventional forceps biopsy.

Abstract

Accurate diagnosis of peripheral pulmonary nodules (PPNS) remains challenging due to their small size and location. Conventional transbronchial forceps biopsy often yields suboptimal tissue samples. Cryobiopsy has emerged as a promising technique to improve diagnostic accuracy.

The objective of this study is to evaluate the diagnostic yield, specimen quality, and safety profile of ultrathin bronchoscopy-guided transbronchial cryobiopsy in patients with PPNS, and to compare it with conventional forceps biopsy.

In this retrospective, observational study conducted from January 2023 to December 2024 at the department of pulmonary medicine, 60 adult patients with CT-confirmed PPNS (8-30 mm) underwent bronchoscopy evaluation using ultrathin bronchoscopy, radial endobronchial ultrasound (R-EBUS), and virtual navigation. Cryobiopsies were obtained using a 1.1 mm cryoprobe, with forceps biopsy performed in 75% of patients for comparison. The primary outcome was diagnostic yield; secondary outcomes included complication rates, specimen size, tissue quality, and procedural metrics.

A definitive histopathological diagnosis was achieved in 48 of 60 cases, yielding an overall diagnostic rate of 80%. Cryobiopsy demonstrated a significantly higher diagnostic yield (85%) compared to forceps biopsy (62%, p < 0.05). Cryobiopsy specimens were significantly larger (5.2 ± 1.1 mm vs 2.1 ± 0.7 mm) with p < 0.05 and had less crush artifact (92% vs 58%). Malignancy was diagnosed in 34 patients (56.7%), with adenocarcinoma being the most common. Complication rates were low; pneumothorax occurred in 2 cases (3.3%) and moderate bleeding in 5 cases (8.3%), all managed conservatively.

Transbronchial cryobiopsy is a safe and superior diagnostic modality for evaluating PPNS, offering higher diagnostic yield and better specimen quality than forceps biopsy. It should be considered an effective, minimally invasive option for tissue acquisition in patients with indeterminate pulmonary nodules. However, the study's single-center design and limited sample size may restrict generalizability.

Introduction

Lung cancer continues to be the leading cause of cancer-related deaths globally, accounting for approximately 1.8 million deaths each year¹. A major challenge in reducing lung cancer mortality is the fact that many patients are diagnosed at an advanced stage, where treatment options are limited and the prognosis is poor. Early detection of lung cancer, particularly when the disease is still localized and potentially curable, significantly improves survival rates². In this context, the implementation of low-dose computed tomography (LDCT) screening in high-risk populations, especially long-term smokers, has marked a signi....

Protocol

This is a reprospective, observational clinical study conducted at the Department of Pulmonary Medicine, Jiangxi Provincial People's Hospital(The First Affiliated Hospital of Nanchang Medical College), from January 2023 to December 2024. The study was approved by the Institutional Ethics Committee of Jiangxi Provincial People's Hospital(The First Affiliated Hospital of Nanchang Medical College) and adhered to the Declaration of Helsinki. Written informed consent was obtained from all participants before inclusion.

NOTE: A total of 60 adult patients with radiologically confirmed peripheral pulmonary nodules (PPNs), ranging from 8 to ....

Results

Participant characteristics
A total of 60 patients were enrolled in the study between January 2023 and December 2024, all of whom presented with peripheral pulmonary nodules. The mean age of participants was 62.4 ± 10.7 years, with an age range spanning from early middle age to elderly patients. The cohort included 34 males (57%) and 26 females (43%), reflecting a slight male predominance. The average nodule size was 18.2 ± 5.7 mm, ranging from 9 mm to 30 mm, suggesting that the study population prim.......

Discussion

PPNS are increasingly identified owing to the widespread application of high-resolution imaging modalities. Despite these advances, obtaining an accurate tissue diagnosis, particularly for small, deep, or peripherally located nodules, continues to present a significant clinical challenge. This study demonstrates that ultrathin bronchoscopy (UTB) combined with transbronchial cryobiopsy (TBLC) provides a higher diagnostic yield and a favorable safety profile compared with conventional forceps biopsy.

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Biopsy forceps	Olympus or equivalent	https://olympusmedical.co.in/products/all-products/endotherapy-devices/pulmonaly-devices/biopsy-forceps/index.html	Standard transbronchial biopsy forceps
Bronchial blocker	Fuji or equivalent	N/A	Alternative to balloon catheter for hemorrhage control
Cryoprobe (1.1 mm)	Erbe Elektromedizin	https://us.erbe-med.com/us-en/products/cryosurgery/cryoprobes-for-erbecryor-2/flexible-cryoprobe-single-use-oe-11-mm/	1.1 mm flexible cryoprobe; used for tissue freezing and biopsy
ECG Monitor	Philips/GE/Schiller	https://www.philips.co.in/healthcare/ambulatory-monitoring-and-diagnostics/ecg-monitoring	For cardiac monitoring during procedures
Fentanyl	Any pharmaceutical company	N/A	Opioid analgesic used during bronchoscopy
Fluoroscope	GE Healthcare or similar	https://www.gehealthcare.com/products/fluoroscopy-systems	Real-time imaging for needle guidance
Fogarty balloon catheter	Edwards Lifesciences	https://www.edwards.com/healthcare-professionals/products-services/vascular-solutions/clot-management	Used for bleeding control during biopsy
Guide sheath (GS)	Olympus	https://olympusmedical.co.in/products/pulmonology/bronchoscopy/endotherapy-devices/guidesheath-systems/index.html	Aids in stabilizing and guiding the bronchoscope
High-resolution CT scanner	Siemens/GE/Philips	https://www.siemens-healthineers.com/computed-tomography/somatom/somatom-force	Imaging for identifying peripheral pulmonary nodules
Midazolam	Any pharmaceutical company	N/A	Sedative used for moderate sedation
Non-invasive BP Monitor	Philips/GE	N/A	For monitoring blood pressure
Pulse oximeter	Masimo/Nellcor	https://www.masimo.com/technology/pulse-oximetry/see-the-difference/	Continuous oxygen saturation monitoring
Radial Endobronchial Ultrasound (r-EBUS)	Olympus	https://medical.olympusamerica.com/products/probes/radial-ebus-probes	Ultrasound probe used to localize lesions
SPSS Software	IBM	v26	Used for statistical analysis
Ultrathin bronchoscope	Olympus or equivalent	https://www.olympus-europa.com/medical/en/Products-and-Solutions/Products/Product/BF-MP190F.html	≤3.0 mm outer diameter; enables access to peripheral nodules
Virtual Bronchoscopy Navigation (LungPoint)	Broncus Medical	https://www.broncus.com/	Pre-procedure navigation and planning system