Evidence map›Paper›PMID 41895580›Full record

ArticleChest2026

Cone Beam CT Imaging-Guided Bronchoscopy vs CT Imaging-Guided Transthoracic Needle Biopsy for Peripheral Pulmonary Lesion Diagnosis.

Pranjal Patel, David E Ost, Brian Shaller, Jiwoon Chang, Aishwarya Yenepalli, Hee Jae Choi, Dwayne Free, Cyra-Yoonsun Kang, Eric Sumner, Carrie Cao and 1 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
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Article in Chest, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

11 authors.

Pranjal PatelDivision of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA. Electronic address: prapatel@stanford.edu.
David E OstDepartment of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
Brian ShallerDivision of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA.
Jiwoon ChangDivision of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA.
Aishwarya YenepalliDepartment of Pulmonary and Critical Care Medicine, University of California Davis Medical Center, Davis, CA.
Hee Jae ChoiDivision of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill, NC.
Dwayne FreeDepartment of Respiratory Care, Stanford Health Care, Stanford, CA.
Cyra-Yoonsun KangDivision of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA.
Eric SumnerDepartment of Pulmonology and Critical Care Medicine, The Permanente Medical Group, Roseville, CA.
Carrie CaoDivision of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA.
Harmeet BediDivision of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe identification of peripheral pulmonary lesions (PPLs) has increased significantly, either incidentally or through lung cancer screening, necessitating more biopsies to differentiate between malignant and benign causes. Cone beam CT imaging-guided bronchoscopic biopsy (CBCT-GB) and CT imaging-guided transthoracic needle biopsy (CT-TTNB) are used commonly for these biopsies, but their comparative diagnostic abilities have not been studied. RESEARCH QUESTION: How does CBCT-GB compare with CT-TTNB for diagnosing PPLs? STUDY DESIGN AND

methodsThis single-center retrospective comparative cohort study analyzed PPLs biopsied at an academic center via either CBCT-GB or CT-TTNB. The primary outcome was diagnostic accuracy at the 24-month follow-up, defined as the proportion of cases yielding a specific diagnosis (malignant or nonmalignant) or a nonspecific diagnosis that remained accurate through 24 months of clinical follow-up. Secondary outcomes included complication rates, procedure duration, radiation exposure, and the need for additional diagnostic procedures.

resultsOf 895 patients analyzed, 340 of 375 patients (90.7%) in the CBCT-GB group and 440 of 475 patients (92.6%) in the CT-TTNB group had a diagnostic result (P = .301; OR, 0.979; 95% CI, 0.939-1.020). Complications occurred in 4.3% of patients undergoing CBCT-GB and 41.6% of patients undergoing CT-TTNB (P < .001). Pneumothorax rates were 1.8% for CBCT-GB and 31.4% for CT-TTNB (P < .001), and severe bleeding or cardiorespiratory failure occurred in 3.3% and 6.0% of patients, respectively (P < .001). Among patients meeting criteria for upfront invasive mediastinal staging, 86.5% of patients undergoing CBCT-GB received it at the time of PPL biopsy, compared with 14.0% of patients after biopsy in the CT-TTNB group (P < .001). Median effective radiation dose was 8.6 mSv in the robotic bronchoscopy CBCT-GB group and 7.5 mSv in the CT-TTNB group (P =.074).

interpretationOur results show that CBCT-GB demonstrated a 24-month diagnostic accuracy comparable with that of CT-TTNB while offering improved safety and concurrent mediastinal lymph node staging. These data support CBCT-GB as the optimal initial procedure for PPL diagnosis.

Indexed as

BronchoscopyCone-Beam Computed TomographyImage-Guided BiopsyLungLung DiseasesLung NeoplasmsAgedBiopsy, NeedleFemaleHumansMaleMiddle AgedRetrospective StudiesTomography, X-Ray Computedcone beam CT imagingdiagnostic accuracydiagnostic yieldgeneral radiologyinterventional pulmonologyinterventional radiologylung cancerlung noduleperipheral pulmonary lesionpulmonary critical carepulmonary nodulerobotic bronchoscopytransthoracic needle aspirationtransthoracic needle biopsy

Identifiers

PMID41895580
PMCPMC13494254

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.