Diagnostic Performance of Radial EBUS-Guided Cryobiopsy for Peripheral Lung Lesions: First Experience in Morocco.

INTRODUCTION

Accurate diagnosis of peripheral pulmonary lesions (PPLs) remains challenging. Conventional forceps biopsy frequently yields small samples compromised by crush artifact. Transbronchial cryobiopsy (TBCB) offers larger, better-preserved specimens. This study evaluated the diagnostic yield and safety of radial endobronchial ultrasound (r-EBUS)-guided TBCB using a 1.1-mm cryoprobe.

MATERIALS AND

METHODS

This prospective single-center study enrolled 73 consecutive patients with PPLs. Procedures were performed under general anesthesia using a laryngeal mask airway, a flexible bronchoscope, r-EBUS for localization, and a 1.1-mm cryoprobe inserted through a guide sheath. A prophylactic bronchial balloon blocker was employed for hemorrhage control. The primary outcome was diagnostic yield; secondary outcomes included bleeding severity and pneumothorax incidence.

RESULTS

Mean lesion diameter was 21 mm, with 79.5% of patients exhibiting a positive bronchus sign. A definitive histological diagnosis was established in 55 of 73 patients (75.3%). Malignancies accounted for 60.3% of diagnoses, whereas benign etiologies, including tuberculosis, represented 15.1%. Bleeding occurred in 19.2% of cases; all events were mild and managed with the balloon blocker. No severe hemorrhage was observed. Pneumothorax occurred in six patients (8.2%), with four requiring chest tube drainage.

CONCLUSION

r-EBUS-guided TBCB using a 1.1-mm cryoprobe is feasible and effective for diagnosing PPLs, with a diagnostic yield of 75.3%. Protocolized use of a balloon blocker effectively prevents severe hemorrhagic complications. Pneumothorax risk warrants vigilance, particularly in patients with infectious cavitary disease.