Procedural Techniques, Airway Management and Specimen Acquisition for Peripheral Lung Transbronchial and Endobronchial Ultrasound Guided Cryobiopsy: A Modified Delphi Consensus Statement.

Abstract

Transbronchial cryobiopsy has expanded beyond its established role in interstitial lung disease, driven by release of single-use cryoprobes, most notably the 1.1-mm cryoprobe. As use of transbronchial cryobiopsy accelerates across non-interstitial lung disease diagnostic contexts, practice variability has outpaced evidence generation and formal guidance. Our objective was to formulate clinical consensus statements regarding indications, tools, techniques, specimen handling, safety considerations, and requisite procedural expertise for the use of the 1.1mm cryoprobe in non-interstitial lung disease transbronchial cryobiopsy, including convex-probe endobronchial ultrasound guided, and peripheral pulmonary lesion, sampling. An international panel of bronchoscopy experts was assembled through the Interventional Pulmonology Outcomes Group. Following a structured evidence review, a modified Delphi methodology was conducted, consisting of an initial round of open-ended questions followed by three rounds in which panelists rated their agreement with statements on a 5-point Likert scale. Consensus was defined a priori as ≥80% agreement. Domains included: (1) peripheral transbronchial cryobiopsy, (2) convex-probe endobronchial ultrasound guided cryobiopsy, (3) airway, anesthesia, and complication management, and (4) specimen handling and processing. A total of 32 physicians participated in this project. The modified Delphi process consisted of four survey rounds conducted between May and November 2025. Consensus was obtained on 31 statements. No consensus was obtained on 17 statements. This Delphi statement represents the first expert guidance for non-interstitial lung disease applications of both endobronchial ultrasound-guided and peripheral transbronchial cryobiopsy. The consensus statements delineate contemporary best practice, bridge critical gaps in standardization, and outline domains where further research is needed.