Modified two-scope technique for transbronchial lung cryobiopsy of peripheral pulmonary lesions

Bleeding mitigation is an important part of any transbronchial lung cryobiopsy (TBLC) procedure, either for interstitial lung disease (ILD) or peripheral pulmonary lesions (PPL). The two-scope technique has been previously described for ILD and PPL-TBLC, but it has its own limitations and technical and logistical complexities. In this case series, we describe a modified two-scope technique that enhances the conventional two-scope technique by maintaining a small equipment footprint and longer bronchoscopic vision without the need for intra-procedure switching of bronchoscopes. Three cases of PPLs were navigated by standard radial endobronchial ultrasound and biopsied with the 1.1 mm flexible ultrathin cryoprobe. All cases achieved a conclusive diagnosis with adequate specimens for immunohistochemical staining and molecular analysis; only Grade 1 bleeding reported in two cases. The challenges and limitations of this modified two-scope technique were also explored in this series.