Performance of transbronchial cryobiopsy in eccentrically and adjacently orientated radial endobronchial ultrasound lesions

Representative case 1. a) Axial computed tomography thorax demonstrates a 2.2 cm peripheral pulmonary lesion over right upper lobe posterior segment; b) radial endobronchial ultrasound revealed an eccentrically orientated lesion; c) placement of 1.9 mm cryoprobe with prophylactic blocking balloon at the ostium of posterior segment of right upper lobe; d) single planar fluoroscopy demonstrating placement of cryoprobe (without guide sheath) and blocking balloon; e) forceps biopsy revealing only bronchial epithelium (haematoxylin and eosin stain (HE), 100-fold magnification); f) cryobiopsy revealing chronic granulomatous inflammation suggestive of tuberculosis (HE, 400-fold magnification).

Representative case 2. a,b) Axial computed tomography thorax demonstrates a solitary pulmonary nodule at anterior segment of right upper lobe in lung and mediastinal window; c) adjacently orientated radial endobronchial ultrasound lesion at target segment; d) placement of cryoprobe via guide sheath into the lesion via fluoroscopy guidance; e) forceps biopsy revealing only superficial peribronchial tissue with cartilage (haematoxylin and eosin stain (HE), ×40-fold magnification); f,g) cryobiopsy confirmed squamous cell carcinoma with positive cytokeratin (CK) 5/6 staining (f, HE, 400-fold magnification; g, CK 5/6 stain, 100-fold magnification).