Linear EBUS – Cryobiopsy

Venerino Poletti
University of Bologna, Bologna, Italy

Transbronchial cryobiopsy of mediastinal and/or central airways is emerging as an important diagnostic tool for both benign and malignant disorders. Procedural aspects are now relatively well defined. Key technical considerations—such as the use of needles or electrosurgical knives to create an access tunnel, optimal freezing time, ultrasound features predictive of complications, and the recommended number of specimens to obtain—have been addressed in several significant publications. The diagnostic yield is well supported by current data, particularly in benign conditions such as sarcoidosis, tuberculosis, Castleman disease, and lymphadenitis, as well as in rare malignant tumors, including intimal pulmonary artery sarcoma and, more frequently, lymphoproliferative disorders. Recent evidence suggests that tissue samples obtained via this method offer a higher diagnostic yield for molecular analyses (e.g., next-generation sequencing) and immunohistochemical testing for immune checkpoint markers, compared to conventional EBUS-TBNA. Complications are uncommon and generally manageable; however, there has been a recent report of tumor seeding along the cryobiopsy tract.