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. 2025 Sep 30;14(9):3518-3528.
doi: 10.21037/tlcr-2025-538. Epub 2025 Sep 25.

Outcomes of radial probe endobronchial ultrasound-guided transbronchial lung cryobiopsy using guide sheath and the target fixing technique

Taehun Kim  1 , Seong Hwan Youn  1 , Mi-Ae Kim  1 , Hyun Jung Kim  1 , Yongshik Kwon  1 , Jae Seok Park  1 , Sun Hyo Park  1
Affiliations

Outcomes of radial probe endobronchial ultrasound-guided transbronchial lung cryobiopsy using guide sheath and the target fixing technique

Taehun Kim et al. Transl Lung Cancer Res. .

Abstract

Background: The need to obtain high-quality samples from lung nodule suspected malignancy is continuing to rise. This study aimed to evaluate the diagnostic yield of radial probe endobronchial ultrasound-guided transbronchial lung cryobiopsy (RP-EBUS-TBLC) using guide sheath (GS) for lung lesions suspected of malignancy on computed tomography (CT).

Methods: This retrospective observational study included patients who underwent RP-EBUS-TBLC using GS between January 2023 and April 2025 in South Korea. We introduced Dohyun's method (a target-fixing technique) used to overcome the respiratory gating of the target during semi-real-time biopsy. After identifying the target lesion, the bronchoscope was inserted and fixed within the segment; the position was maintained while RP-EBUS was withdrawn, and the lesion stability during respiration was confirmed.

Results: The final inclusion of 120 patients was analyzed. After the exclusion of patients with an indeterminate diagnosis, the final diagnostic yield was 94.8% (90.8% to 95.0% considering indeterminate diagnosis). The sensitivity and specificity were 93.7% and 100.0%, respectively. Pneumothorax occurred in 5.0% (6/120) of patients. Grade 3 or higher bleeding was observed in two patients, and a Fogarty balloon catheter was preemptively used in five patients at the operator's discretion. In the multivariate logistic regression, the CT-bronchus sign emerged as the only significant factor associated with pathological confirmation. However, lesion size, eccentricity, and lower lung distribution were not significantly associated.

Conclusions: RP-EBUS-TBLC using GS demonstrated high diagnostic yield and acceptable safety for the diagnosis of lung lesions. Dohyun's method may facilitate continuous targeting of lesions during semi-real-time biopsy, particularly in cases where respiratory motion and non-within-RP-EBUS target lesions present challenges.

Keywords: Radial probe endobronchial ultrasound (RP-EBUS); guide sheath (GS); target fixing technique; transbronchial lung cryobiopsy (TBLC).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-2025-538/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram illustrating the participant selection process. RP-EBUS-TBLC performed via a GS, not otherwise specified. GS, guide sheath; NOS, not otherwise specified; RP-EBUS-TBLC, radial probe endobronchial ultrasound-guided transbronchial lung cryobiopsy.
Figure 2
Figure 2
Schematic diagram illustrating the Dohyun’s method (target-fixing method).
Figure 3
Figure 3
Diagnostic outcomes of the study participants. RP-EBUS-TBLC performed via a GS, not otherwise specified. GS, guide sheath; NOS, not otherwise specified; RP-EBUS-TBLC, radial probe endobronchial ultrasound-guided transbronchial lung cryobiopsy.
Video S1
Video S1
Real-time target movement observed with RP-EBUS before the application of Dohyun’s method. The target nodule is identified with RP-EBUS, but it appears and disappears repeatedly depending on the patient’s breathing. RP-EBUS, radial probe endobronchial ultrasound.
Video S2
Video S2
Real-time target stabilization observed with RP-EBUS after the application of Dohyun’s method. After Dohyun’s method, the target was observed continuously regardless of breathing. RPEBUS, radial probe endobronchial ultrasound.
See this image and copyright information in PMC

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