Procedural Techniques, Airway Management, and Specimen Acquisition for Peripheral Lung Transbronchial and Endobronchial Ultrasound-Guided Cryobiopsy: A Modified Delphi Consensus Statement.

BACKGROUND

Transbronchial cryobiopsy has expanded beyond its established role in interstitial lung disease, driven by release of single-use cryoprobes, most notably the 1.1 mm cryoprobe. As use of transbronchial cryobiopsy accelerates across non-interstitial lung disease diagnostic contexts, practice variability has outpaced evidence generation and formal guidance.

RESEARCH QUESTION: What are areas of clinical consensus regarding indications, tools, techniques, specimen handling, safety considerations, and requisite procedural expertise for the use of the 1.1 mm cryoprobe in non-interstitial lung disease transbronchial cryobiopsy, including convex-probe endobronchial ultrasound-guided and peripheral pulmonary lesion sampling?

STUDY DESIGN AND

METHODS

An international panel of bronchoscopy experts was assembled through the Interventional Pulmonology Outcomes Group. Following a structured evidence review, a modified Delphi methodology was conducted, consisting of an initial round of open-ended questions followed by 3 rounds in which panelists rated their agreement with statements on a 5-point Likert scale. Consensus was defined a priori as ≥ 80% agreement. Domains included: (1) peripheral transbronchial cryobiopsy, (2) convex-probe endobronchial ultrasound-guided cryobiopsy, (3) airway, anesthesia, and complication management, and (4) specimen handling and processing.

RESULTS

A total of 32 physicians participated in this project. The modified Delphi process consisted of 4 survey rounds conducted between May and November 2025. Consensus was obtained on 31 statements. No consensus was obtained on 17 statements.

INTERPRETATION: To our knowledge, this Delphi statement represents the first expert guidance for non-interstitial lung disease applications of both endobronchial ultrasound-guided and peripheral transbronchial cryobiopsy. The consensus statements delineate contemporary best practices, bridge critical gaps in standardization, and outline domains where further research is needed.