Background: Recently introduced cryobiopsy can provide quantitatively and qualitatively excellent tissues. However, few studies have directly compared the diagnostic yield of cryobiopsy for peripheral pulmonary lesions (PPLs) with that of conventional biopsy.

Methods: Consecutive patients who underwent bronchoscopy using radial endobronchial ultrasound and virtual bronchoscopic navigation for PPLs (October 2015 to September 2020) were retrospectively reviewed. Patients who underwent cryobiopsy were assigned to the cryo group, whereas those who did not undergo cryobiopsy were assigned to the conventional group. The diagnostic yield of both groups was compared using propensity score-matched analysis.

Results: A total of 2,724 cases were identified; 492 and 2,232 in the cryo and conventional groups, respectively. Propensity scoring was performed to match baseline characteristics, 481 pairs of cases were selected for each matched group (m-group). The diagnostic yield was significantly higher in the m-cryo group than in the m-conventional group (89.2% vs. 77.6%, odds ratio = 2.36 [95% confidence interval = 1.65?3.38], p< 0.001). The subgroup analysis revealed that cryobiopsy was notably effective for lesions in the middle lobe/lingula, right/left lower lobe, lesions with ground-glass opacity, and lesions invisible on chest radiography. Although there were more cases of grade 2/3 bleeding in the m-cryo group than in the m-conventional group (38.0% vs. 10.2% and 1.5% vs. 0.8%, respectively; p< 0.001), no grade 4 bleeding was observed.

Conclusion: The propensity score-matched analysis revealed that cryobiopsy was associated with a higher diagnostic yield for PPLs than conventional biopsy.