{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T13:53:47Z","timestamp":1791726827729,"version":"4.3.4"},"reference-count":17,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Peripheral pulmonary lesions (PPLs) are increasingly detected due to widespread use of cross-sectional imaging and lung cancer screening. While cone-beam CT and robotic bronchoscopy have improved diagnostic accuracy, they remain resource-intensive and inaccessible in many settings. A novel technique employing simultaneous use of two bronchoscopes referred to as the \u201cKissing Probe Technique\u201d was developed to provide real-time lesion localization and precise sampling using standard equipment. Methods: This retrospective, single-centre study included 43 patients with radiologically confirmed PPLs suspicious for malignancy. Under general anaesthesia with rigid bronchoscopy or continuous sedation with endotracheal intubation, two single-use bronchoscopes were introduced in parallel. The first (standard diameter) housed a radial EBUS probe for lesion localization, while the second (ultra-thin) guided a 1.1 mm cryoprobe to the lesion based on direct ultrasound and fluoroscopic confirmation. Cryobiopsies were performed once \u201ckissing contact\u201d between the radial probe and cryoprobe was established. Results: A total of 43 procedures were completed without major complications. The mean lesion size was 24.6 mm. Radial probe localization was successful in 86% of cases, and tool-contact confirmation was achieved in 35\/43 patients (81%). The overall diagnostic yield was 83.7% (36\/43). Bleeding occurred in 23% of cases and was managed conservatively without the need for escalation of care. No pneumothorax or equipment-related damage occurred. Conclusions: The \u201cKissing Probe Technique\u201d is a safe and feasible approach for bronchoscopic sampling of PPLs. It offers a cost-effective alternative for real-time tool-in-lesion confirmation using widely available equipment. Further multicentre validation is warranted to confirm generalizability and cost-effectiveness.<\/jats:p>","DOI":"10.3390\/jcm14186425","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T07:52:28Z","timestamp":1757663548000},"page":"6425","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Simultaneous Use of Dual Bronchoscopes for Targeted Biopsy of Peripheral Lung Lesions: The Kissing Probe Technique"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5774-074X","authenticated-orcid":false,"given":"Sammy","family":"Onyancha","sequence":"first","affiliation":[{"name":"Department of Pulmonology, St. Elisabethen Krankenhaus, 60596 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Njuxhersa","family":"Maloku","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, St. Elisabethen Krankenhaus, 60596 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Dettmer","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, St. Elisabethen Krankenhaus, 60596 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gernot","family":"Rohde","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, St. Elisabethen Krankenhaus, 60596 Frankfurt, Germany"},{"name":"Department of Respiratory Medicine, Medical Clinic I, University Hospital, Goethe University Frankfurt, 60596 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1148\/radiol.2015142554","article-title":"CT Screening for Lung Cancer: Nonsolid Nodules in Baseline and Annual Repeat Rounds","volume":"277","author":"Yankelevitz","year":"2015","journal-title":"Radiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1378\/chest.11-1764","article-title":"Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule","volume":"142","author":"Nietert","year":"2012","journal-title":"Chest"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"240046","DOI":"10.1183\/16000617.0046-2024","article-title":"Diagnostic yield and safety of diagnostic techniques for pulmonary lesions: Systematic review, meta-analysis and network meta-analysis","volume":"33","author":"Balasubramanian","year":"2024","journal-title":"Eur. Respir. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"361","DOI":"10.21037\/atm-22-2845","article-title":"Cone-beam CT in lung biopsy: A clinical practice review on lessons learned and future perspectives","volume":"11","author":"Verhoeven","year":"2023","journal-title":"Ann. Transl. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/LBR.0000000000000366","article-title":"A Single US Center Experience of Transbronchial Lung Cryobiopsy for Diagnosing Interstitial Lung Disease with a 2-Scope Technique","volume":"24","author":"Sriprasart","year":"2017","journal-title":"J. Bronchol. Interv. Pulmonol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"17534666251355130","DOI":"10.1177\/17534666251355130","article-title":"Comparative diagnostic performance and safety of radial endobronchial ultrasound versus its combination with electromagnetic or virtual bronchoscopic navigation for peripheral pulmonary lesions: A retrospective study","volume":"19","author":"Qi","year":"2025","journal-title":"Ther. Adv. Respir. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Zhang, Q., Wen, F., Wu, X., Yang, H., Li, X., Luo, P., Liu, H., Wang, Z., Herth, F.J.F., and Zhang, X. (2025). Shape sensing robotic assisted bronchoscopy versus virtual bronchoscopic navigation in the diagnosis of peripheral pulmonary nodules. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-08798-2"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1097\/LBR.0000000000000883","article-title":"Diagnostic Yield of Cone-beam-Derived Augmented Fluoroscopy and Ultrathin Bronchoscopy Versus Conventional Navigational Bronchoscopy Techniques","volume":"30","author":"DiBardino","year":"2023","journal-title":"J. Bronchol. Interv. Pulmonol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Lin, C.K., Fan, H.J., Yao, Z.H., Lin, Y.T., Wen, Y.F., Wu, S.G., and Ho, C.C. (2021). Cone-Beam Computed Tomography-Derived Augmented Fluoroscopy Improves the Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Biopsy for Peripheral Pulmonary Lesions. Diagnostics, 12.","DOI":"10.3390\/diagnostics12010041"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"5953","DOI":"10.21037\/jtd.2018.09.16","article-title":"Biopsy of peripheral lung nodules utilizing cone beam computer tomography with and without trans bronchial access tool: A retrospective analysis","volume":"10","author":"Sobieszczyk","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"107196","DOI":"10.1016\/j.lungcan.2023.107196","article-title":"Diagnostic yield and safety of navigation bronchoscopy: A systematic review and meta-analysis","volume":"180","author":"Kops","year":"2023","journal-title":"Lung Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"100037","DOI":"10.1016\/j.chpulm.2024.100037","article-title":"The Diagnostic Yield of Cone Beam CT Combined With Radial-Endobronchial Ultrasound for the Diagnosis of Peripheral Pulmonary Nodules: Systematic Review and Meta-Analysis","volume":"2","author":"Brown","year":"2024","journal-title":"CHEST Pulm."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1111\/1759-7714.14733","article-title":"Diagnostic yield of radial probe endobronchial ultrasonography-guided transbronchial biopsy without fluoroscopy in peripheral pulmonary lesions: A systematic review and meta-analysis","volume":"14","author":"Lee","year":"2023","journal-title":"Thorac. Cancer"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"00135","DOI":"10.1183\/23120541.00135-2019","article-title":"Performance of transbronchial cryobiopsy in eccentrically and adjacently orientated radial endobronchial ultrasound lesions","volume":"5","author":"Kho","year":"2019","journal-title":"ERJ Open Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"30","DOI":"10.21037\/amj-23-178","article-title":"Role of single-use flexible bronchoscopes","volume":"9","author":"Podder","year":"2024","journal-title":"AME Med. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1007\/s41669-023-00417-y","article-title":"Systematic Review and Cost-Consequence Analysis of Ambu aScope 5 Broncho Compared with Reusable Flexible Bronchoscopes: Insights from Two US University Hospitals and an Academic Institution","volume":"7","author":"Kristensen","year":"2023","journal-title":"PharmacoEconomics-Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1097\/LBR.0000000000000936","article-title":"A Cone Beam CT Bronchoscopy Study of the Ultrathin Cryoprobe for Biopsy of Peripheral Lung Lesions","volume":"31","author":"Bhadra","year":"2024","journal-title":"J. Bronchol. Interv. Pulmonol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6425\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:44:15Z","timestamp":1760035455000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6425"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,12]]},"references-count":17,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14186425"],"URL":"https:\/\/doi.org\/10.3390\/jcm14186425","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,12]]}}}