Background and Objective: Indwelling pleural catheters (IPC) relieve symptoms in malignant pleural effusion (MPE), while maintaining a reasonable quality of life. However, the high cost of the catheter and the drainage bottles limits their use in low- and middle-income countries. The objective of this study was to determine the time to pleurodesis, feasibility and safety while reusing a low-cost adaptor kit for IPC drainage in a retrospective cohort of patients with MPE. Methods: Consecutive patients undergoing IPC insertion over 5 years at a tertiary cancer center were included. IPCs were preferably inserted on outpatient basis, and drained at home using an adaptor kit and syringe. Talc pleurodesis was offered on lung re-expansion and reduction in drainage. IPC was removed if pleurodesis was achieved, after which follow up was done till 1 year. Results: The study included 69 patients. Twenty-five (36.2%) patients achieved pleurodesis during follow up after 40 (IQR 30-62) days. Thirteen patients who had undergone talc instillation achieved pleurodesis after 34 (IQR 21-40) days as compared to 46.5 (IQR 40-73.5) days in the 12 patients with spontaneous pleurodesis (P = 0.06). We recorded 12 (17.4%) severe adverse events. Pleurodesis failure was noted in 2 (11.1%) patients after IPC removal. Conclusion: IPC was an effective treatment in adults with MPE with an acceptable incidence of adverse events when aspirated using adaptor kit. Studies comparing IPC and intercostal drainage tubes in our setting are needed.

280 Background: 18 FDG PET-CT is standard for mediastinal staging of NSCLC, but its specificity is low in tuberculosis-endemic regions. Because EBUS-TBNA is an imperfect reference standard, we quantified agreement and directional discordance between PET and EBUS cytology. Methods: This retrospective, blinded diagnostic concordance study included 52 patients with biopsy-confirmed stage III A-C NSCLC who underwent both PET-CT and EBUS-TBNA for initial mediastinal staging. A nuclear medicine specialist, blinded to original reports and EBUS results, re-interpreted de-identified PET-CT DICOM images. EBUS-TBNA served as the imperfect reference standard. Primary endpoint was station-level agreement quantified by Cohen’s κ with patient-cluster bootstrap 95% CIs. Secondary analyses included overall agreement, Byrt/Bishop/Carlin prevalence and bias indices, station-group strata (N2 vs N1) and echelon strata. Station-level diagnostic metrics were estimated with cluster-bootstrap CIs. Patient-level N2/N3 positivity concordance used standard κ and exact McNemar’s test. Discordance characterization compared SUV max and short-axis diameter between PET+/EBUS+ vs PET+/EBUS− stations (Wilcoxon). SUV max discrimination for EBUS positivity was assessed by ROC AUC (DeLong and cluster-bootstrap CIs) and Youden thresholds. Sensitivity analyses tested varying EBUS sensitivity assumptions. Results: Station-level agreement was slight (κ = 0.177; 95% CI: −0.008 to 0.371), with 42.3% discordance. The discordance pattern was anatomically asymmetric: at N2 mediastinal stations (n = 88), κ was 0.255 (fair agreement), driven by PET+/EBUS− discordance (33% FP vs 7% FN) and at N1 hilar stations (n = 16), κ was −0.125, driven by PET−/EBUS+ discordance (44% FN vs 13% FP). Echelon-stratified analysis showed best agreement at echelon 2 (subcarinal/ipsilateral station 4; κ = 0.301) with FP-dominant error, and symmetric poor agreement at echelon 3 (contralateral mediastinum; κ = 0.111). At the patient level, PET showed 91.7% concordance sensitivity but only 35.7% specificity for N2/N3 disease, with strongly directional discordance (McNemar’s p = 0.0004). PET+/EBUS− stations had significantly lower SUV max (median 5.4 vs 8.8, p = 0.002) and smaller nodes (median 12 vs 18 mm, p < 0.001) than concordant positives. Of 13 PET−/EBUS+ stations, 84.6% had no visible node on PET. ROC analysis yielded an AUC of 0.760 (95% CI: 0.627–0.890); the Youden-optimal threshold (SUV max > 7.2) achieved 80.0% specificity versus 11.1% at the traditional 2.5 cutoff. Imperfect-reference sensitivity analysis (EBUS sensitivity 86–97%) minimally changed κ (0.165–0.173). Conclusions: Station-level agreement between PET-CT and EBUS-TBNA is slight. PET has high patient-level sensitivity but poor specificity for N2/N3 disease, causing directional over-calling. EBUS-TBNA is necessary for PET-positive mediastinal nodes.

To quantify concordance between blinded PET-CT reinterpretation and EBUS-guided transbronchial needle aspiration (EBUS-TBNA) cytology for mediastinal lymph node staging in locally advanced NSCLC in a tuberculosis-endemic lower-middle income country (LMIC). Retrospective, single-institution blinded concordance study of 52 consecutive Stage IIIA–C NSCLC patients. A nuclear medicine physician, blinded to all clinical data, reinterpreted deidentified PET-CT images. Patient-level agreement (any N2/N3 involvement) was assessed using Cohen’s κ and McNemar’s test. Among 75 PET-visible EBUS-sampled stations, SUVmax discriminative performance was evaluated by ROC. Candidate thresholds were applied to the patient-level classification to assess performance. Inclusion of nodal stations into radiotherapy volumes was also assessed. Patient-level agreement was fair (κ = 0.26; 95

PURPOSE OF REVIEW:Airway foreign body aspiration remains a potentially life-threatening emergency, predominantly affecting children under 5 years and adults over 65 years. This review synthesizes current evidence on diagnostic strategies, bronchoscopic extraction techniques, procedural outcomes, complication management, and emerging technologies in airway foreign body management. RECENT FINDINGS:Multidetector computed tomography with three-dimensional reconstruction has significantly improved diagnostic accuracy, achieving sensitivity of 98-99% for radiopaque objects and 85-92% for radiolucent materials. Flexible bronchoscopy has evolved from a diagnostic tool to a first-line therapeutic modality, with recent pediatric meta-analyses demonstrating 87% success rates and adult series showing comparable outcomes to rigid bronchoscopy for appropriately selected cases. Rigid bronchoscopy maintains superiority in asphyxiating presentations, and for large (>1.5 cm), sharp, or severely impacted foreign bodies. Technological innovations including robotic-assisted bronchoscopy, electromagnetic navigation systems, and artificial intelligence-powered imaging analysis are enhancing procedural precision and safety. SUMMARY:Successful airway foreign body management requires individualized, multidisciplinary approaches integrating patient clinical status, foreign body characteristics, and institutional expertise. Success depends on appropriate bronchoscopic modality selection, comprehensive preprocedural planning, availability of specialized retrieval instruments, and readiness to manage potential complications. Integration of advanced imaging, simulation-based training protocols, and telemedicine consultation are becoming essential components of contemporary practice.

Background: Endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS-TBNA) has replaced mediastinoscopy as the preferred investigation for evaluating mediastinum in staging lung cancer. There is little evidence of mediastinal staging by EBUS-TBNA from India. Objectives: To study endobronchial ultrasound's diagnostic accuracy in staging lung cancer. Methodology: We retrospectively analysed patients operated on for lung cancer where EBUS was performed preoperatively for mediastinal staging. We compared the histological findings obtained from different mediastinal lymph nodes (LNs) by EBUS-TBNA with the pathology of the same LNs obtained after surgical dissection as the reference standard. Results: Seventy-six patients underwent curative surgery for lung cancer. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of EBUS-TBNA in predicting mediastinal metastasis were 93.9%, 40%, 99%, 80% and 94.6%, respectively. Of the 115 LNs sampled, EBUS-TBNA was false negative in six nodes, resulting in an up-staging of six patients. Conclusions: EBUS-TBNA has a high diagnostic accuracy for lung cancer staging.

Over the past decade, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become an indispensable tool in the diagnostic armamentarium of the pulmonologist. As the expertise with EBUS-TBNA has evolved and several innovations have occurred, the indications for its use have expanded. However, several aspects of EBUS-TBNA are still not standardized. Hence, evidence-based guidelines are needed to optimize the diagnostic yield and safety of EBUS-TBNA. For this purpose, a working group of experts from India was constituted. A detailed and systematic search was performed to extract relevant literature pertaining to various aspects of EBUS-TBNA. The modified GRADE system was used for evaluating the level of evidence and assigning the strength of recommendations. The final recommendations were framed with the consensus of the working group after several rounds of online discussions and a two-day in-person meeting. These guidelines provide evidence-based recommendations encompassing indications of EBUS-TBNA, pre-procedure evaluation, sedation and anesthesia, technical and procedural aspects, sample processing, EBUS-TBNA in special situations, and training for EBUS-TBNA.

Background: Pulmonologists commonly need to take biopsies of laryngeal lesions, either found incidentally while doing bronchoscopy for other indications or while investigating patients for hoarseness of voice and cough. Biopsy of laryngeal lesions has been conventionally done under general anesthesia to provide adequate samples and minimize risks and patient discomfort. Of late, these biopsies have been done as outpatient procedures, by flexible endoscopes, under local anesthesia. However, vocal cord biopsies are often challenging due to poor patient compliance. We have tested an innovative method, which we have called the “inside-out” method, to circumvent this problem. Objectives: We aimed to analyze the feasibility, yield, and the safety of the “inside-out” technique for taking vocal cord biopsies as an outpatient procedure in awake patients. Material and Methods: This was a prospective observational study. Data of 38 patients with vocal cord lesions in whom the above technique was employed were analyzed. Results: The procedure had a diagnostic yield of 78.9% with a sensitivity of 96.7% and a specificity of 100% for detecting malignancy or dysplasia. There were no major complications. Conclusions: The “inside-out” technique was found to be feasible and safe and with a high yield.

Sir, The coronavirus (COVID-19) disease, with flu-like symptoms in its mild form, causes a diffuse involvement of both lungs in most of the patients with moderate to severe disease. One of the complications, seen in such patients is the development of a pneumothorax.[1] This is particularly difficult to treat if it persists due to a bronchopleural fistula (BPF). Definitive treatment of these cases with surgery is often difficult as they have bilateral lung involvement and are hypoxic. In similar cases, bronchoscopic occlusion of the leaking segment has been described including some innovative techniques.[23456] However, none of these procedures have been done in COVID-19 patients. We present one such case where we were successful in treating the BPF by bronchoscopic treatment. A 44 years old, diabetic and hypertensive male, was referred to us with complaints of cough, left-sided chest pain and shortness of breath. He was being treated in another hospital for COVID-19 pneumonia complicated by a left-sided pneumothorax for the last two months. He had an intercostal tube drain (ICD) in place, with a persistent large air leak, and was sent to us for definitive treatment. At the time of presentation, the patient was conscious but tachypnoeic with a respiratory rate of 32 and oxygen saturation (SPO2) of 79% on room air. Chest examination revealed absent breath sounds on the left side. He was admitted to the intensive care unit (ICU) and had to be supported with non-invasive ventilation (NIV) despite a BPF, due to his inability to maintain oxygen saturation by other means including a high flow nasal cannula (HFNC). His initial investigations showed a high total leucocyte count (TLC) of 33,000/mm3, so he was put on broad-spectrum antibiotics. Imaging including a computed tomography (CT) scan showed a partially expanded left lung with a pneumothorax and an ICD in situ. The lungs on both sides showed residual infiltrates of the COVID-19 and also bullae in both apices [Figure 1a and b]. A trial of slow negative suction to the intercostal tube was tried but failed. Over the next few days, due to the supportive measures above, his oxygen requirement gradually decreased, and he could be taken off NIV. However, the large air leak persisted. In view of clinical improvement, definitive treatment was planned. Surgery seemed too risky due to bilateral diseased lungs, so a bronchoscopic intervention, to occlude the bronchus leading to the leaking segment, was planned under general anaesthesia.Figure 1: (a) Xray chest with left pneumothorax. (b) CT scan with left side pneumothorax and bilateral apical bullaeAfter taking a high-risk informed consent, the patient was given general anaesthesia and ventilated with a laryngeal mask airway (LMA). After an initial examination with a therapeutic video bronchoscope, a 6F Fogarty balloon was passed through the working channel into the left lung and serial balloon occlusion of the different segments was done. The leak was finally localised to the upper division of the left upper lobe after which it was decided to seal the upper division. An endoscopic Watanabe spigot (EWS) size 5, was held with a rat tooth forceps, after passing it through the working channel of the bronchoscope. The bronchoscope and the EWS, were together, carefully passed through the LMA into the left main bronchus. The EWS was then deposited at the opening of the upper division and then manipulated and pushed into the apical segment (LB2) [Figure 2]. Once the spigot was in place, the adjacent LB1 and the LB3 segments were sealed with n-butyl cyano-acrylate glue instilled through thin catheters to make sure that whole of the upper division was sealed off. The procedure was deemed finished when the ICD showed that the air leak had stopped completely.Figure 2: EWS in left upper lobe apical segmentNegative suction was reapplied to the ICD and continued for another day. A repeat chest imaging showed resolution of pneumothorax. To prevent a recurrence, pleurodesis was done with talc slurry through an ICD tube. Post pleurodesis, the chest X-ray showed no pneumothorax [Figure 3]. The ICD was removed on the subsequent day. He was discharged and an X-ray after 4 weeks showed no evidence of pneumothorax. Supplementary oxygen was discontinued and the patient restarted normal activity. The patient has been advised to return after a year for a repeat bronchoscopy and removal of the EWS.Figure 3: X-ray chest after bronchial occlusion and pleurodesis, showing complete resolution of pneumothoraxThis case report of bronchoscopic occlusion of a persistent BPF with a EWS and glue, in a COVID-19 patient, shows that a non-surgical approach can be successful. As has been reported in a large series, about 1% of severe COVID-19 patients developed unilateral and sometimes bilateral pneumothoraces, with or without pneumomediastinum.[1] Some of these patients have been difficult to treat due to BPF, persistent respiratory failure and lack of a surgical option. The above approach may be tried in selected cases to overcome this dreaded complication. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Background: The COVID-19 pandemic has created an unprecedented crisis, affecting every sphere of human life. A major challenge for health care workers (HCWs) is to care for patients with a highly contagious airborne disease, while making sure of their own safety. Interventional pulmonology (IP) procedures, like bronchoscopy, are particularly risky due to significant aerosol generation. Guidelines by several scientific bodies were framed on the precautions to be taken while performing IP procedures. We evaluated the IP procedures performed during the COVID-19 pandemic, and whether the precautions adopted proved adequate in preventing transmission amongst the HCWs involved in these procedures. Method: We performed a retrospective analysis of all patients who underwent IP procedures between March 2020 and November 2020, at a tertiary cancer hospital. We also evaluated the proportion of HCWs, who were involved in these procedures, and were affected by COVID-19, through their health care records. Results: We performed a total of 506 IP procedures. Two of the 18 HCWs, working in that unit, suffered from COVID-19 and recovered after a mild illness. Three HCWs were isolated with suspected infection but proved to be negative. The procedures in our IP unit were uninterrupted for the entire duration of the study period. Conclusion: IP procedures can be safely performed even in the presence of a highly contagious viral pandemic with adequate precautions.

Airway foreign body can be a medical emergency and is associated with significant morbidity and occasionally even death. The presentation may be acute, especially in children, who may manifest with respiratory failure requiring immediate intervention. In adults, the presentation is usually subacute and occasionally chronic. The initial step is confirmation of the diagnosis by performing flexible bronchoscopy. In majority of the cases, flexible bronchoscopy is therapeutic, and can be used successfully to remove a foreign body. Rigid bronchoscopy, however, may be required in younger children, in those with an asphyxiating foreign body or in situations where attempts with a flexible bronchoscope are unsuccessful. Herein, we discuss the various aspects of airway foreign body and the tools that are used for removing airway foreign body. In addition, we provide practical tips in handling and removing different types of airway foreign bodies.

During the times of the ongoing COVID pandemic, aerosol-generating procedures such as bronchoscopy have the potential of transmission of severe acute respiratory syndrome coronavirus 2 to the healthcare workers. The decision to perform bronchoscopy during the COVID pandemic should be taken judiciously. Over the years, the indications for bronchoscopy in the clinical practice have expanded. Experts at the Indian Association for Bronchology perceived the need to develop a concise statement that would assist a bronchoscopist in performing bronchoscopy during the COVID pandemic safely. The current Indian Association for Bronchology Consensus Statement provides specific guidelines including triaging, indications, bronchoscopy area, use of personal protective equipment, patient preparation, sedation and anesthesia, patient monitoring, bronchoscopy technique, sample collection and handling, bronchoscope disinfection, and environmental disinfection concerning the coronavirus disease-2019 situation. The suggestions provided herewith should be adopted in addition to the national bronchoscopy guidelines that were published recently. This statement summarizes the essential aspects to be considered for the performance of bronchoscopy in COVID pandemic, to ensure safety for both for patients and healthcare personnel.

Bronchial thermoplasty (BT) is an interventional bronchoscopic treatment for severe asthma. There is a need to define patient selection criteria to guide clinicians in offering the appropriate treatment options to patients with severe asthma. Methodology: An expert group formed this statement under the aegis of the Indian Chest Society. We performed a systematic search of the MEDLINE and EMBASE databases to extract evidence on patient selection and the technical performance of BT. Results: The experts agreed that the appropriate selection of patients is crucial and proposed identification of the asthma phenotype, a screening algorithm, and inclusion/exclusion criteria for BT. In the presence of atypical clinical or chest radiograph features, there should be a low threshold for obtaining a thoracic computed tomography scan before BT. The patient should not have had an asthma exacerbation in the preceding two weeks from the day of the procedure. A 5-day course of glucocorticoid should be administered, beginning three days before the procedure day, and continued until the day following the procedure. General Anesthesia (total intravenous anesthesia with a neuromuscular blocker) provides ideal conditions for performing BT. A thin bronchoscope with a 2.0 mm working channel is preferable. An attempt should be made to deliver the maximum radiofrequency activations. Middle lobe treatment is not recommended. Following the procedure, overnight observation in the hospital, and a follow-up visit, a week following each treatment session, is desirable. Conclusion: This position statement provides practical guidance regarding patient selection and the technical performance of BT for severe asthma.

Purpose: No report of rigid bronchoscopy (RB) has been described from Singapore. Methods: We did a retrospective review of medical records of patients undergoing RB between November 2009 and November 2019 at Tan Tock Seng Hospital. Results: 135 patients underwent 203 RB. RB was done for malignant central airway obstruction (MCAO) in 91 and benign diseases in 44 patients. The techniques used were Nd: YAG laser (n= 56), stenting (n= 63), transbronchial needle aspiration (n= 5), clot removal (n= 9), ballooning (n= 15), argon plasma coagulation (n= 5), and electrocautery (n = 37). Procedural complications occurred in three (2.2%). Median survival was 10.1 months (interquartile range [IQR], 2.2 to 45.3) in the whole group, 7.8 (IQR, 2 to 18.3) in MCAO and 42.6 (IQR, 8.9 to 77.5) in benign diseases respectively. Twenty-two (16.3%) patients requiring intensive care unit survived for 7.1 months (IQR, 1.6 to 9.8) after RB. Twenty-eight (21%) patients required repeat RB 68 times. Of these 34 (50%) were for granulation tissue removal. Conclusion: RB was safe and improved survival however, the demand was low. The most common indications were re-canalization of MCAO and granulation tissue removal. The later was the most resource consuming indication for repeat RB. Future research should focus on minimization of granulation tissue formation.

Introduction: Endobronchial Ultrasound Guided Transbronchial Needle aspiration (EBUS-TBNA) is a firmly established modality for diagnostic evaluation of mediastinal lesions. Transesophageal approach for fine needle aspiration of mediastinal lesions using the Endobronchial Ultrasound scope has been described as a safe and efficacious modality.We performed a prospective randomized study of utility & safety of Transesophageal (EUS-B-FNA) approach for fine needle aspiration using the same EBUS scope in patients referred for endosonographic evaluation of mediastinal lesions. Methods: Subjects undergoing EBUS-TBNA were enrolled after taking a written informed consent. EUSB FNAC was done in patients where the mediastinal lesion could not be visualized endobronchially with EBUS or had intolerance to bronchoscopy. Results: 60 lymph nodes or mediastinal lesions were sampled via the esophagus with the EBUS scope in 55 patients, majority being subcarinal lymph nodes(39), mediastinal lesions(12), left paratracheal lymph nodes(6), right paratracheal lymph nodes (2) & 1 paraesophageal node. The most common reason for switching to the esophageal route was either intolerance of bronchoscopy due to cough (30), deasturation (5) or endobronchial bleed(6) & better visualized areas by EUS-B-FNA inaccessible by EBUS-TBNA(14). The average size of the node or mass was 20x14.6mm. No complications seen. Operator and patient comfort was seen to be significantly better with EUS-B-FNA. Need for sedation was also noted to be lower. Conclusion: This study confirmed the safety & efficacy of this technique especially in patients with poor tolerance to bronchoscopy & bronchoscopically invisible lesions.

Background: A peripheral, bronchoscopically invisible lung lesion is a diagnostic challenge. Radial endobronchial ultrasound (R-EBUS) has been shown to improve bronchoscopic diagnosis of peripheral pulmonary lesions. We present our results of R-EBUS in the diagnosis of bronchoscopically invisible lesions in a cancer hospital in India. Aims and Objectives: (1) To determine the yield of R-EBUS for the diagnosis of bronchoscopically invisible lesions. (2) To study the different factors that affect the yield of procedure like size of lesion, tumour bronchus relation, use of forceps versus cryobiopsies in the diagnosis of these lesions. Methods: A retrospective analysis of patients(n=251) presenting between January 2015 and November 2019 with bronchoscopically invisible peripheral pulmonary lesions was done. R-EBUS was used to localize and sample the lesion and whenever needed fluoroscopy and thin bronchoscope was used to help localize the lesion.Forceps and/or cryo biopsy were used to sample the lesions and the yield was analyzed. Results: A definite diagnosis was obtained in 66.9% (168/251) patients with no major complications.Statistically significant difference was found on comparing yield between (1)small (<3 cm) and large (>3 cm) lesions: 52.3% versus 73.9%(p=0.005) and (2) central and adjacent lesion: 70.4% versus 53.8%(p=0.015). No statistically significant difference was found on comparing yield between forceps and cryobiopsy:66.9% versus 72.1%(p=0.502). Conclusions: R-EBUS is a safe procedure in our setting and its yield is comparable to that reported in literature with a significantly higher yield in >3 cm lesions and central lesions.

in TBLC has been reported not only with respect to complications but also with respect to the quality and size of the biopsies.In a previous study, Almeida and colleagues assessed 100 TBLCs performed in patients with suspected diffuse lung disease (2).When they compared the first 50 TBLCs with the next 50 TBLCs, they found that the length and area of the biopsies were smaller and the diagnostic yield was lower in the first group, and all parameters improved when the bronchoscopists gained more experience.In their study, Almeida and colleagues reported a median length of 5.0 mm in the first 50 biopsies and 6.0 mm in the next 50 biopsies.Romagnoli and colleagues reported a level of agreement between external blinded versus local pathology reports as fair to moderate, with k values of 0.22-0.51.The k values for individual pathologists are not presented, and as noted above for bronchoscopy, there may be a learning curve for pathologic evaluations of cryobiopsies.In support of this, previous studies (which included the same external pathologist as in the present study) reported k values between 0.59 and 0.61 (5,6).With regard to the agreement between the pathologic diagnosis based on the two types of specimens and the final diagnosis at the second multidisciplinary assessment or the final treatment (Table 2 andTable E3 in the online supplement of Reference 1), there is no statistically significant difference by conventional standards between the two types of specimens in terms of performance when evaluated by a chi-square test or Fisher's exact test on simple 2 3 2 tables, even though there is trend in favor of SLB.This emphasizes the need for further research into this important subject before any conclusions can be made.The TBLCs were compared with SLBs as the gold standard.However, the accuracy of SLB has never been proven, and previous studies (7) have clearly shown that SLBs can also provide discordant results when performed in different lobes; thus, the perception of SLB as the gold standard requires careful consideration.The study by Romagnoli and colleagues certainly indicates that more research into the accuracy of TBLC is warranted, but their results cannot stand alone and should not discourage the continued use of TBLC in interstitial lung disease.

Background: Bronchoscopic lung cryobiopsy (BLC) is a novel technique for obtaining lung tissue for the diagnosis of diffuse parenchymal lung diseases. The procedure is performed using several different variations of technique, resulting in an inconsistent diagnostic yield and a variable risk of complications. There is an unmet need for standardization of the technical aspects of BLC. Methodology: This is a position statement framed by a group comprising experts from the fields of pulmonary medicine, thoracic surgery, pathology, and radiology under the aegis of the Indian Association for Bronchology. Sixteen questions on various technical aspects of BLC were framed. A literature search was conducted using PubMed and EMBASE databases. The expert group discussed the available evidence relevant to each question through e-mail and a face-to-face meeting, and arrived at a consensus. Results: The experts agreed that patients should be carefully selected for BLC after weighing the risks and benefits of the procedure. Where appropriate, consideration should be given to perform alternate procedures such as conventional transbronchial biopsy or subject the patient directly to a surgical lung biopsy. The procedure is best performed after placement of an artificial airway under sedation/general anesthesia. Fluoroscopic guidance and occlusion balloon should be utilized for positioning the cryoprobe to reduce the risk of pneumothorax and bleeding, respectively. At least four tissue specimens (with at least two of adequate size, i.e., ≥5 mm) should be obtained during the procedure from different lobes or different segments of a lobe. The histopathological findings of BLC should be interpreted by an experienced pulmonary pathologist. The final diagnosis should be made after a multidisciplinary discussion. Finally, there is a need for structured training for performing BLC. Conclusion: This position statement is an attempt to provide practical recommendations for the performance of BLC in DPLDs.