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.