The rising role of cryobiopsy in diagnosis of pulmonary disorders: a narrative review

Abstract

Background and Objective: Transbronchial lung biopsy using forceps and/or needle aspirations have been the primary available tools of bronchoscopy for evaluation of interstitial lung disease (ILD), peripheral lung lesions, and lymphadenopathy. However, these have been limited in optimizing diagnostic yield comparative to other diagnostic procedural modalities that are associated with higher complication rates. Herein, the objective is to summarize the current knowledge regarding the application of cryobiopsy for evaluation of the aforementioned pulmonary processes and anticipated future directions towards understanding and optimizing its performance and feasibility for application. Methods: Publications pertaining to cryobiopsy and bronchoscopy were searched on PubMed up to 2024. These studies were stratified and selected particularly for application for diagnosis of ILD, peripheral lung lesions, and lymph nodes. Key Content and Findings: While the techniques of bronchoscopy and cryoprobe have existed for far longer, the two concepts have only been merged for the inception of cryobiopsy in the past few decades. In disease processes in which even the steps of diagnosis—let alone the dilemmas that are to be faced in management—has been historically complicated and delayed due to high risk of surgical biopsies, cryobiopsy holds the potential to be a safer and potentially equivalent, if not preferred, alternative. With recognition of the need for further practice and experience to establish standard protocols and guidelines for its use, this review aims to address the current known data of the application of cryobiopsy in evaluation of ILD, peripheral lung nodules, and lymph node evaluations. The current primary limitations for application of cryobiopsy are relative paucity of data to support diagnostic yield, safety profile, and the familiarity and training with cryobiopsy. The safety profile of cryobiopsy, particularly with the smaller 1.1 mm probes, appears more favorable than raised by prior concerns. While reported diagnostic yield and concordance is more variable, the safety profile in comparison to the morbidity of alternative diagnostic procedures may favor cryobiopsy for initial evaluation of certain diseases with lung involvement. Conclusions: Early findings of application of cryobiopsy in assessment of pulmonary parenchymal disease, peripheral lesions and lymphadenopathy are promising with improved diagnostic yield compared to standard transbronchial biopsies. As traction gains with training and application of cryobiopsy, additional studies are needed to elucidate how to further optimize diagnostic yield and minimize complications.