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The current standard for diagnostic evaluation of diffuse parenchymal lung disease relies on multidisciplinary consensus (MDC) involving clinical, radiographic and histopathologic information. Transbronchial cryobiopsy is emerging as a viable alternative to surgical biopsy with equivalent diagnostic yield and better safety profile. The optimal positioning of the cryoprobe near pleura improves diagnostic yield and decreases complications. Fluoroscopic guidance is common during cryobiopsy but accuracy is limited to biopsy of segments where airways are perpendicular to the A-P axis. Use of radial EBUS can help avoid vessels but does aid in probe placement. Cone beam CT (CBCT) has demonstrated a high degree of accuracy for biopsy of pulmonary nodules and has feasibility in transbronchial cryobiopsy. The use of CBCT guidance for cryobiopsy may improve diagnostic yield and minimize complications by allowing targeting of abnormal areas.

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