Comparison of diagnostic yield between electromagnetic navigation bronchoscopy-guided forceps biopsy and target-fixing technique-assisted RP-EBUS-guided transbronchial cryobiopsy with a guide sheath for peripheral lung lesions.

BACKGROUND: Accurate diagnosis of peripheral lung lesions remains challenging, particularly for small nodules. Electromagnetic navigation bronchoscopy (ENB) improves access to peripheral airways but shows variable diagnostic yield. Radial probe endobronchial ultrasound-guided transbronchial cryobiopsy with a guide sheath (RP-EBUS-guided TBC with GS) allows semi-real-time lesion confirmation and acquisition of larger tissue samples. This study compared the diagnostic yield and safety of ENB-guided biopsy and RP-EBUS-guided TBC. METHODS: This retrospective observational study included patients who underwent ENB-guided transbronchial biopsy or RP-EBUS-guided TBC with a GS for lung lesions suspected to be malignant on computed tomography between May 2021 and December 2025 in South Korea. Propensity score matching was applied using logistic regression with a caliper width of 0.2 standard deviation (SD) of the logit of the propensity score, adjusting for lesion size, axial distribution, lobe location, nodule characteristics, and bronchus sign. RESULTS: Matching resulted in 201 pairs, although some baseline imbalances remained. The overall diagnostic yield was significantly higher for RP-EBUS-guided TBC than for ENB (91.1% vs. 73.4%, P<0.001). Sensitivity for malignancy was also higher with RP-EBUS-guided TBC (88.4% vs. 73.3%, P<0.001). In the matched cohort, RP-EBUS-guided TBC was significantly associated with higher diagnostic yield [odds ratio (OR) 2.715, P<0.001] and sensitivity (OR 3.897, P<0.001). Pneumothorax occurred more frequently in the RP-EBUS-guided TBC group; however, the difference was not statistically significant (OR 2.054, P=0.20). CONCLUSIONS: RP-EBUS-guided TBC with a GS was associated with a higher diagnostic yield than ENB-guided forceps biopsy, without a statistically significant increase in major complications in patients with peripheral lung lesions.