October 2026

PULMONARY

RANDOMIZED TRIAL FINDS CRYOBIOPSY IMPROVES DIAGNOSTIC YIELD OF LUNG BIOPSY COMPARED TO FORCEPS

Featuring: Christopher M. Kapp, MD
​
A new randomized trial, FROSTBITE-2, set out to test if a 1.1-millimeter cryoprobe offered a better diagnostic yield of transbronchial lung biopsy than forceps. Published in JAMA, and co-authored by Christopher M. Kapp, MD, the trial enrolled 500 patients across nine U.S. sites who were undergoing biopsy for pulmonary nodules or masses, post-lung-transplant evaluation or diffuse parenchymal lung disease.

Results
  • Diagnostic yield was 88.6% with cryobiopsy versus 78.8% with forceps.
  • The yield was significantly higher with cryobiopsy for pulmonary nodules and masses (83.2% vs. 70.1%) and for lung transplant evaluation (96.0% vs. 88.7%).
  • For diffuse parenchymal lung disease, cryobiopsy trended higher (72.0% vs. 62.5%) but didn't reach statistical significance, likely reflecting the smaller subgroup size.

Despite retrieving larger tissue samples, the cryoprobe group had:
  • No cases of significant bleeding or respiratory failure
  • Zero pneumothoraces requiring chest tube placement
    • 1.6% of patients in the forceps group needed this.

​Clinical Implications
Whether ruling in malignancy, monitoring transplant rejection or characterizing interstitial lung disease, these findings offer strong evidence that a 1.1-millimeter cryoprobe can be a safe, more diagnostically reliable alternative to conventional forceps for transbronchial biopsy.
Christopher M. Kapp, MD, Assistant Professor of Pulmonary and Critical Care

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