{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T06:45:38Z","timestamp":1792651538522,"version":"4.5.0"},"reference-count":42,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T00:00:00Z","timestamp":1647561600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Transbronchial cryobiopsy (TBCB) is being studied in the diagnosis of peripheral lung lesions; however, there are only a few clinical studies around the world. The aim of our study was to evaluate the diagnostic values and safety of transbronchial cryobiopsy for radiologically suspected peripheral lung cancer. The prospective clinical study was executed from September 2019 to September 2021 at a tertiary clinical centre in Lithuania. A total of 48 patients out of 102 underwent combined procedures of transbronchial forceps biopsy (TBFB) and TBCB. Diagnostic values and safety outcomes of TBFB and TBCB were analysed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were 72.9%, 100%, 100%, 7.7%, and 88.0% for TBFB, 85.1%, 100%, 100%, 12.5%, and 93% for TBCB, as well as 91.5%, 100%, 100%, 20.0% and 96.7% for the combined procedures, respectively, with a significantly higher accuracy for cryobiopsies compared to forceps biopsies (p &lt; 0.05). The diagnostic values for transbronchial cryobiopsies were similar, irrespective of the radial mini probe endobronchial ultrasound (RP-EBUS) position, lesion size or bronchus sign, however, the sensitivity of the combined procedures in cases with RP-EBUS adjacent to the target was significantly higher compared to TBFB (86.2% vs. 64.3%, p = 0.016). Samples of cryobiopsies were significantly larger than forceps biopsies (34.62 mm2 vs. 4.4 mm2, p = 0.001). The cumulative diagnostic yield of transbronchial cryobiopsy was 80.0% after the second biopsy and reached a plateau of 84.1% after four biopsies. No severe bleeding, pneumothorax, respiratory failure or death was registered in our study. TBCB is a potentially safe procedure, which increases diagnostic values in diagnosing peripheral lung lesions compared to TBFB.<\/jats:p>","DOI":"10.3390\/cancers14061563","type":"journal-article","created":{"date-parts":[[2022,3,20]],"date-time":"2022-03-20T21:25:00Z","timestamp":1647811500000},"page":"1563","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Diagnostic Yield of Transbronchial Cryobiopsy Guided by Radial Endobronchial Ultrasound and Fluoroscopy in the Radiologically Suspected Lung Cancer: A Single Institution Prospective Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Vytautas","family":"Ankudavicius","sequence":"first","affiliation":[{"name":"Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Skaidrius","family":"Miliauskas","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Poskiene","sequence":"additional","affiliation":[{"name":"Department of Pathology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3769-3520","authenticated-orcid":false,"given":"Donatas","family":"Vajauskas","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius","family":"Zemaitis","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1016\/j.annonc.2020.02.009","article-title":"European cancer mortality predictions for the year 2020 with a focus on prostate cancer","volume":"31","author":"Carioli","year":"2020","journal-title":"Ann. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"ii1","DOI":"10.1136\/thoraxjnl-2015-207168","article-title":"British Thoracic Society guidelines for the investigation and management of pulmonary nodules: Accredited by NICE","volume":"70","author":"Callister","year":"2015","journal-title":"Thorax"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/j.jtcvs.2016.10.019","article-title":"A nomogram for predicting the risk of invasive pulmonary adenocarcinoma for patients with solitary peripheral subsolid nodules","volume":"153","author":"Jin","year":"2017","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"djx075","DOI":"10.1093\/jnci\/djx075","article-title":"Cigarette Filter Ventilation and its Relationship to Increasing Rates of Lung Adenocarcinoma","volume":"109","author":"Song","year":"2017","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Sardarabadi, P., Kojabad, A.A., Jafari, D., and Liu, C.H. (2021). Liquid Biopsy-Based Biosensors for MRD Detection and Treatment Monitoring in Non-Small Cell Lung Cancer (NSCLC). Biosensors, 11.","DOI":"10.3390\/bios11100394"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1513\/AnnalsATS.201311-384OC","article-title":"Radial probe endobronchial ultrasound for peripheral pulmonary lesions. A 5-year institutional experience","volume":"11","author":"Chen","year":"2014","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.patol.2019.05.002","article-title":"Correlation between transbronchial lung biopsy and lung cytology","volume":"53","author":"Jois","year":"2019","journal-title":"Rev. Espa\u00f1ola Patol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"131S","DOI":"10.1378\/chest.07-1357","article-title":"American College of Chest Physicians. Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines","volume":"132","author":"Rivera","year":"2007","journal-title":"Chest"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1183\/09031936.00075310","article-title":"Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: Systematic review and meta-analysis","volume":"37","author":"Steinfort","year":"2010","journal-title":"Eur. Respir. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S1047","DOI":"10.21037\/jtd.2017.05.48","article-title":"Bronchoscopy for the diagnosis of peripheral lung lesions","volume":"9","author":"Dhillon","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1016\/j.chest.2020.05.534","article-title":"Sensitivity and Safety of Electromagnetic Navigation Bronchoscopy for Lung Cancer Diagnosis","volume":"158","author":"Folch","year":"2020","journal-title":"Chest"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1159\/000489934","article-title":"Diagnostic Yield of Computed Tomography-Guided Transthoracic Lung Biopsy in Diffuse Lung Diseases","volume":"96","author":"Rodrigues","year":"2018","journal-title":"Respiration"},{"key":"ref_13","first-page":"47","article-title":"Computed Tomography-guided Transthoracic Core Needle Biopsy of Lung Masses: Technique, Complications and Diagnostic Yield Rate","volume":"54","author":"Temel","year":"2020","journal-title":"Med. Bull. Sisli Etfal Hosp."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/S2213-2600(19)30342-X","article-title":"Diagnostic accuracy of transbronchial lung cryobiopsy for interstitial lung disease diagnosis (COLDICE): A prospective, comparative study","volume":"8","author":"Troy","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1159\/000456671","article-title":"Transbronchial Lung Cryobiopsy in Diffuse Parenchymal Lung Disease: Comparison between Biopsy from 1 Segment and Biopsy from 2 Segments-Diagnostic Yield and Complications","volume":"93","author":"Ravaglia","year":"2017","journal-title":"Respiration"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2186","DOI":"10.21037\/jtd.2017.06.96","article-title":"Transbronchial cryobiopsy for diffuse parenchymal lung disease: A state-of-the-art review of procedural techniques, current evidence, and future challenges","volume":"9","author":"Lentz","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1186\/s12931-019-1162-3","article-title":"Comparison of tumor cell numbers and 22C3 PD-L1 expression between cryobiopsy and transbronchial biopsy with endobronchial ultrasonography-guide sheath for lung cancer","volume":"20","author":"Arimura","year":"2019","journal-title":"Respir. Res."},{"key":"ref_18","first-page":"1828","article-title":"Diagnostic Yield and Complications of Transbronchial Lung Cryobiopsy for Interstitial Lung Disease: A Systematic Review and Metaanalysis","volume":"13","author":"Johannson","year":"2016","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.chest.2020.01.036","article-title":"Standardized definitions of bleeding after transbronchial lung biopsy: A Delphi consensus statement from the Nashville Working Group","volume":"158","author":"Folch","year":"2020","journal-title":"Chest"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1378\/chest.129.3.734","article-title":"Effect of Routine Clopidogrel Use on Bleeding Complications After Transbronchial Biopsy in Humans","volume":"129","author":"Ernst","year":"2006","journal-title":"Chest"},{"key":"ref_21","first-page":"1","article-title":"Bronchoscopic sampling techniques in the era of technological bronchoscopy","volume":"S2531-0437","author":"Mondoni","year":"2020","journal-title":"Pulmonology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1590\/s1806-37562016000000379","article-title":"Radial-probe EBUS for the diagnosis of peripheral pulmonary lesionsAUTHORS\u2019 REPLYRadial-probe EBUS for the diagnosis of peripheral pulmonary lesionsFactors influencing visibility and diagnostic yield of transbronchial biopsy using endobronchial ultrasound in peripheral pulmonary lesionsRadial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: Systematic review and meta-analysis","volume":"43","author":"Guarize","year":"2017","journal-title":"J. Bras. Pneumol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1111\/resp.12980","article-title":"Radial endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions: A systematic review and meta-analysis","volume":"22","author":"Ali","year":"2017","journal-title":"Respirology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1097\/LBR.0000000000000288","article-title":"Safety and Efficacy of Radial EBUS for the Investigation of Peripheral Pulmonary Lesions in Patients With Advanced COPD","volume":"23","author":"Georgiou","year":"2016","journal-title":"J. Bronchol. Interv. Pulmonol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"319","DOI":"10.4046\/trd.2018.0082","article-title":"Diagnostic Performance of Radial Probe Endobronchial Ultrasound without a Guide-Sheath and the Feasibility of Molecular Analysis","volume":"82","author":"Moon","year":"2019","journal-title":"Tuberc. Respir. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1183\/09031936.00011313","article-title":"Endobronchial ultrasound-guided cryobiopsies in peripheral pulmonary lesions: A feasibility study","volume":"43","author":"Schuhmann","year":"2014","journal-title":"Eur. Respir. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1111\/crj.13301","article-title":"Endobronchial ultrasound guided transbronchial cryobiopsy versus forceps biopsy in peripheral lung lesions","volume":"15","author":"Torky","year":"2021","journal-title":"Clin. Respir. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"5683","DOI":"10.21873\/anticanres.13766","article-title":"Comparison of the Utilities of Cryobiopsy and Forceps Biopsy for Peripheral Lung Cancer","volume":"39","author":"Nasu","year":"2019","journal-title":"Anticancer Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.arbres.2014.02.018","article-title":"Diagnosis of peripheral pulmonary lesions with radial probe endobronchial ultrasound-guided bronchoscopy","volume":"50","author":"Boonsarngsuk","year":"2014","journal-title":"Arch. Bronconeumol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.resinv.2017.08.004","article-title":"The efficacy of transbronchial needle aspiration with endobronchial ultrasonography using a guide sheath for peripheral pulmonary lesions suspected to be lung cancer","volume":"55","author":"Arimura","year":"2017","journal-title":"Respir. Investig."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1159\/000444089","article-title":"Safety and Diagnostic Yield of Transbronchial Lung Cryobiopsy in Diffuse Parenchymal Lung Diseases: A Comparative Study versus Video-Assisted Thoracoscopic Lung Biopsy and a Systematic Review of the Literature","volume":"91","author":"Ravaglia","year":"2016","journal-title":"Respiration"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1016\/j.chest.2021.05.015","article-title":"Diagnostic Outcomes and Safety of Cryobiopsy Added to Conventional Sampling Methods: An Observational Study","volume":"160","author":"Matsumoto","year":"2021","journal-title":"Chest"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"6032974","DOI":"10.1155\/2018\/6032974","article-title":"Diagnostic Yield of Combined Pulmonary Cryobiopsies and Electromagnetic Navigation in Small Pulmonary Nodules","volume":"2018","author":"Taton","year":"2018","journal-title":"Pulm. Med."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Eom, J.S., Mok, J.H., Kim, I., Lee, M.K., Lee, G., Park, H., Lee, J.W., Jeong, Y.J., Kim, W.Y., and Jo, E.J. (2018). Radial probe endobronchial ultrasound using a guide sheath for peripheral lung lesions in beginners. BMC Pulm. Med., 18.","DOI":"10.1186\/s12890-018-0704-7"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.resinv.2014.10.003","article-title":"Endobronchial ultrasound-guided transbronchial biopsy with or without a guide sheath for diagnosis of lung cancer","volume":"53","author":"Minami","year":"2015","journal-title":"Respir. Investig."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Griff, S., Sch\u00f6nfeld, N., Ammenwerth, W., Blum, T.-G., Grah, C., Bauer, T.T., Gr\u00fcning, W., Mairinger, T., and Wurps, H. (2014). Diagnostic yield of transbronchial cryobiopsy in non-neoplastic lung disease: A retrospective case series. BMC Pulm. Med., 14.","DOI":"10.1186\/1471-2466-14-171"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2488","DOI":"10.1111\/cas.14489","article-title":"Feasibility and utility of transbronchial cryobiopsy in precision medicine for lung cancer: Prospective single-arm study","volume":"111","author":"Udagawa","year":"2020","journal-title":"Cancer Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.rppnen.2017.09.005","article-title":"Learning curve for transbronchial lung cryobiopsy in diffuse lung disease","volume":"24","author":"Almeida","year":"2018","journal-title":"Pulmonology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.resinv.2018.12.011","article-title":"Management and utility of transbronchial lung cryobiopsy in Japan","volume":"57","author":"Kuse","year":"2019","journal-title":"Respir. Investig."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1016\/j.chest.2021.04.063","article-title":"Safety and Performance of Transbronchial Cryobiopsy for Parenchymal Lung Lesions","volume":"160","author":"Herth","year":"2021","journal-title":"Chest"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Imabayashi, T., Uchino, J., Yoshimura, A., Chihara, Y., Tamiya, N., Kaneko, Y., Yamada, T., and Takayama, K. (2019). Safety and Usefulness of Cryobiopsy and Stamp Cytology for the Diagnosis of Peripheral Pulmonary Lesions. Cancers, 11.","DOI":"10.3390\/cancers11030410"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Simon, M., Simon, I., Tent, P.A., Todea, D.A., and Harangus, A. (2021). Cryobiopsy in Lung Cancer Diagnosis\u2014A Literature Review. Medicina, 57.","DOI":"10.3390\/medicina57040393"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/6\/1563\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:39:08Z","timestamp":1760135948000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/6\/1563"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,18]]},"references-count":42,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["cancers14061563"],"URL":"https:\/\/doi.org\/10.3390\/cancers14061563","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,18]]}}}