Radial endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) enhances diagnostic yield in pulmonary nodule biopsy.

BACKGROUND

Diagnosing pulmonary lesions remains challenging despite various modalities. The PeriView Flex aspiration needle offers a promising solution to forceps biopsy limitations. This study aims to assess whether combining radial endobronchial ultrasound (rEBUS)-guided transbronchial needle aspiration (TBNA) and transbronchial lung biopsy (TBLB) may enhance tissue acquisition for inaccessible lesions using forceps.

METHODS

This retrospective study included 33 patients with pulmonary lesions who underwent a combination of rEBUS-guided TBNA and TBLB between September 2023 and August 2024. Diagnostic yields were calculated using a strict definition and were compared with those of propensity score-matched controls who underwent rEBUS-guided TBLB alone.

RESULTS

The median age of the cohort was 68 years, with a male-to-female ratio of 1.2:1.0. About 65% of lesions were in the outer two-thirds of the thorax, with a median size of 16.75 mm (interquartile range: 13.00-23.88 mm). Most lesions were solid (81.8%), followed by consolidation (9.1%), part-solid (6.1%) and cavitary lesions (3%). In our cohort, 21.2% had type Ia and 15.2% had type Ib, classified as favorable bronchial patterns on computed tomography (CT). However, approximately two-thirds had unfavorable bronchial patterns, including type Ic (12.1%), IIa (45.5%), and IIb (6.1%). An adjacent rEBUS view was present in 52% of the cases. The combined TBNA-TBLB approach achieved a diagnostic yield of 66.7%, which was highest in CT bronchus types Ia and Ib (83.3%) and lowest in types Ic, IIa, and IIb (57.1%). Propensity score matching (1:3) showed a higher diagnostic yield with TBNA-TBLB (66.7%) than with TBLB alone (48.5%), P=0.10. Post-procedural pneumothorax occurred in one patient (3.0%) in TBNA-TBLB group compare to 2.3% in TBLB group.

CONCLUSIONS

Adding TBNA to TBLB improved the diagnostic yield for pulmonary nodules with adjacent or tunnel-type bronchi. This combined approach offers a practical strategy for enhancing diagnostic accuracy.