{"\ufeffTRANSBRONCHIAL LUNG CRYOBIOPSY FOR DIFFUSE AND LOCALIZED PERIPHERAL PULMONARY LESIONS: A RETROSPECTIVE REVIEW OF OUR EARLY EXPERIENCE\nB. H. Ng1, C. I. Soo2, M. Z. Nasaruddin3, U. N. Daut3, N. A. Muhammad3, K. L. Ng3, N. H. M. Aminudin3, N. C. Huan3, F. A. Mohammad3, S. Zulkifli3, L. H. Fui3, M. A. A. Onny3, A. Y. Ban1, J. A. A. Rahaman3\n\n1Respiratory Unit, Department of Medicine, National University of Malaysia (UKM) Medical Center, 56000, Cheras, Kuala Lumpur, Malaysia\n2Division of Respiratory Medicine, Department of Medicine, University of Malaya Medical Center, 59100, Kuala Lumpur, Malaysia\n3Department of Pulmonology, Serdang Hospital, 43000, Serdang, Selangor, Malaysia\n \n*Corresponding author:  \nC. I. Soo, Division of Respiratory Medicine, Department of Medicine, University of Malaya Medical Center, 59100, Kuala Lumpur, Malaysia. Telephone: +603-79492966. Email: scianray@gmail.com\n \nDOI: https://doi.org/10.32896/tij.v2n4.1-13\nSubmitted: 12.08.2022\nAccepted: 22.11.2022\nPublished: 31.12.2022 \n\nABSTRACT: \nBackground: Transbronchial lung cryobiopsy (TBLC) is an emerging technique for obtaining lung biopsy. This retrospective study aimed to evaluate the performance and safety of TBLC performed on diffuse peripheral pulmonary lesions (DPPL) and localized peripheral pulmonary lesions (LPPL).\nMethods: 58 patients underwent TBLC. They were divided into two groups (DPPL and LPPL) based on radiological findings. The patients\u2019 demographic data, procedural details, complications, and radiological and pathologic diagnostic results were analyzed.\nResults: The overall diagnostic yield for TBLC was 72.4%. In the subgroup analysis, the diagnostic yield was 74.3% for DPPL and 69.6% for LPPL. For LPPL, the overall diagnostic yield was 87.5% and 12.5% for lesions with positive and negative bronchus signs, respectively (P ": "0.01). In both groups, the success of TBLC was not influenced by the size, number, or location of the biopsy. Thirty-two (82%) patients had mild bleeding, while six (15.4%) had moderate bleeding. Pneumothorax occurred in four (6.9%) patients, with three patients requiring chest tube drainage. The mean duration of hospital stay was longer for patients who either bled or developed pneumothorax compared to those who did not (5.64 days vs. 3.47 days", " P ": "0.014) and (14.25 days vs. 4.24 days", " 1 in 10,000), or argon plasma coagulator was one interventional option used before the balloon was reinflated for another 60 s. A chest radiograph was performed for all patients 2 h post-procedure for the evaluation of pneumothorax.\n\nHistological Evaluation\nThe specimens were fixed in 10% buffered formalin solution and were carefully evaluated by a pathologist with more than five years of experience. The variables specified by the literature as important for evaluating the performance and safety of TBLC, such as the number of specimens, the corresponding biopsy site, and each specimen\u2019s size, were inspected carefully and recorded prior to full evaluation. \nThe biopsy results were identified as indicating either interstitial lung disease or malignancy based on histological diagnoses: 1 ": "interstitial lung disease: (a) usual interstitial pneumonia, (b) nonspecific interstitial pneumonia, (c) organizing pneumonia, (d) hypersensitive pneumonitis, (e) granulomatous lung disease, (f) pneumoconiosis, and (g) eosinophilic pneumonia", " 2 ": "malignancy: (a) lung adenocarcinoma, (b) small cell lung carcinoma, (c) carcinoid tumor, (d) lung squamous cell carcinoma, and (e) metastatic disease", " and 3 ": null, " RML: Right middle lobe": null, " LUL: Left upper lobe": null, " RLL: Right lower lobe": null, " LLL: Left lower lobe.\n\nSafety Analysis\nThe safety outcome of TBLC for DPPL and LPPL is presented in Table 8. Bleeding complications were observed in 39 cases (67.2%)": null, " 32 (82%) patients bled mildly, and six (15.4%) bled moderately. One (2.6%) patient suffered severe bleeding, required a blood transfusion, and had a prolonged stay in the intensive care unit (five days) post-procedure. The mean duration of hospital stay was longer for patients who bled than those who did not (5.64 days vs. 3.47 days": null, " NSIP: non-specific interstitial pneumonia": null, " OP: organizing pneumonia": null, " HP: hypersensitivity pneumonitis\n\nTable 3: Radiological pattern of LPPL.\nLPPL (n ": null, "198(5):e44-68.\n    2. Lettieri CJ, Veerappan GR, Helman DL, Mulligan CR, Shorr AF. Outcomes and safety of surgical lung biopsy for interstitial lung disease. Chest. 2005": null, "127(5):1600-5.\n    3. Bradley B, Branley HM, Egan JJ, Greaves MS, Hansell DM, Harrison NK, et al. 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