Transbronchial cryobiopsy: how to do it safely?

Transbronchial cryobiopsy (TBC) is a bronchoscopic procedure for obtaining larger and higher quality peripheral lung biopsies with less crush artifact as compared to conventional transbronchial lung biopsy. It has demonstrated a higher diagnostic yield than the traditional forceps biopsy and thus has generated significant interest as a minimally invasive diagnostic tool for the diagnosis of diffuse parenchymal lung disease (DPLD) in recent years. However, the possibility of intra-operative bleeding, pneumothorax, and other postoperative complications have raised significant concerns. More recently, studies on postoperative complications, morbidity, and mortality as well as the use of techniques to prevent complications of this procedure have been published. Expert guidelines with graded recommendations based on the GRADE approach have been released. Ours is an updated review of practices to perform TBC safely; classified as pre-procedural, intraoperative and postoperative practices that can be adopted and applied in clinical practice based on current evidence to decrease the incidence of adverse outcomes.