Diagnostic Yield and Molecular Testing Adequacy of Transbronchial Cryoprobe Biopsy Versus Needle Aspiration in Robotic Bronchoscopy

Background:

In the AQuIRE trial, most cases (83.6%) did not involve transbronchial needle aspiration (TBNA), often underutilized due to challenges in accessing peripheral pulmonary lesions (PPLs). Advances in robotic bronchoscopy with shape-sensing technology (ssRAB) have mitigated these challenges, but the optimal number of needle and cryoprobe passes for reliable diagnosis remains undefined.

Methods:

This retrospective study compares the diagnostic yield (DY) of TBNA and transbronchial cryoprobe biopsy (TBCB) and their adequacy for molecular testing in PPLs.

We performed a retrospective analysis of 166 patients who underwent ssRAB with both TBNA and TBCB from May to August 2024. Fisher exact tests and McNemar χ ² tests were used to compare prevalence differences in DY and molecular testing adequacy between discordant cases. Odds ratios (OR) and 95% CIs of associations between the number of passes and diagnostic yield and rates of obtaining adequate samples for molecular testing were obtained using generalized linear mixed models (GLMMs) with a logit link.

Results:

TBCB demonstrated a higher diagnostic rate than TBNA (89% vs. 80%, OR=2.04, 95% CI=1.06-4.03; P =0.032), as well as better rates of obtaining samples adequate for molecular testing (60% vs. 20%, OR=5.94, 95% CI=2.31-16.38, P <0.001). TBCB provided diagnostic yields in 55% ( χ ² =9.33, P =0.002) of cases where TBNA failed to provide a diagnosis and was able to obtain adequate samples for molecular testing in 42% ( χ ² =15.06, P <0.001) of cases where TBNA was unable to.

Conclusion:

TBCB suggests a higher diagnostic yield and higher cellular adequacy for molecular testing compared with TBNA, underscoring its potential value as a reliable and versatile diagnostic tool in PPLs.