Cone-Beam Computed Tomography-Guided Cryobiopsy Combined with Conventional Biopsy for Ground Glass Opacity-Predominant Pulmonary Nodules

<b><i>Introduction:</i></b> Cryobiopsy (CB) using a 1.1-mm cryoprobe under fluoroscopic guidance is feasible and safe for diagnosis of ground glass opacity (GGO) lesions. However, the efficacy of CB combined with cone-beam CT (CBCT) for GGO-predominant pulmonary nodules remains elusive. <b><i>Methods:</i></b> We retrospectively studied patients who underwent CB combined with conventional biopsy under CBCT guidance for GGO-predominant pulmonary nodules with a consolidation-to-tumour ratio &lt;50.0%. <b><i>Results:</i></b> A total of 32 patients with GGO-predominant pulmonary nodules were enrolled: 17 pure GGOs and 15 mixed GGOs. The mean lesion diameter was 15.81 ± 5.52 mm and the overall diagnostic yield was 71.9%. Seven lesions were diagnosed by CB alone, which increased the diagnostic outcomes by 21.9%. Diagnostic yields for CB, forceps biopsy (FB), brushing, and guide sheath flushing were 65.6%, 46.9%, 15.6%, and 14.3%, respectively. Univariate analysis revealed that positive computed tomography (CT) bronchus sign (<i>p</i> = 0.035), positive CBCT sign (<i>p</i> &lt; 0.01), and CB-first biopsy sequence (<i>p</i> = 0.036) were significant predictive factors for higher diagnostic yield. Specimens obtained by CB had larger mean sample size (<i>p</i> &lt; 0.01), lower blood cell area (<i>p</i> &lt; 0.01), and fewer crush artefacts (<i>p</i> &lt; 0.01) than specimens from FB. No severe bleeding or other complications occurred. <b><i>Conclusion:</i></b> CB using a 1.1-mm cryoprobe under CBCT guidance increased diagnostic yield for GGO-predominant pulmonary nodules based on conventional biopsy. Further, it provided larger and nearly intact samples compared with forceps.