ArticleJournal of thoracic disease2026
Usefulness of the multimodal biopsy approach in radial endobronchial ultrasound biopsy for peripheral lung lesions: a single center retrospective study.
Article in Journal of thoracic disease, 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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Abstract
Background: Radial endobronchial ultrasound (rEBUS) transbronchial lung biopsy (TBLB) has substantially advanced the bronchoscopic evaluation of peripheral lung lesions (PLLs). Nevertheless, despite improving the overall diagnostic yield (DY), its efficacy remains restricted, with reported yields generally around 60%. To address this limitation, we aimed to assess whether the addition of larger forceps biopsy (LFB) or needle aspiration (NA) to TBLB could increase both DY and the diagnostic tissue acquisition rate (DTAR). In this context, diagnostic tissue acquisition means the acquisition of sufficient tissue to perform ancillary immunohistochemistry or molecular tests. Methods: From the Ulsan University Hospital rEBUS registry, we primarily isolated patients who underwent rEBUS biopsy procedure for a PLL from September 2021 (to July 2023), when LFB [toothed, outer diameter (OD) 1.9 mm] and NA (PeriView FLEX needle, OD 1.5 mm) began to be performed in earnest at our institution. Among them, cases in which multimodal (i.e., two or more) biopsy approach was performed were retrospectively recruited. Results: In a total of 151 patients, LFB or NA was additionally performed in addition to TBLB [TBLB + LFB (n=120), TBLB + LFB + NA (n=25), TBLB + NA (n=6)]. A total of 68.2% [103/151, 95% confidence interval (CI): 60.4-75.1%] were successfully diagnosed by TBLB. Among 48 not diagnosed by TBLB, 12 were further diagnosed by LFB or NA [making the overall DY 76.2% (115/151, 95% CI: 68.8-82.3%)]. The cases in which diagnostic tissue acquisition was secured by TBLB were only 52.3% (79/151, 95% CI: 44.4-60.1%). Twenty-eight were further secured with the addition of LFB or NA [making the overall DTAR 70.9% (107/151, 95% CI: 63.2-77.5%)]. Conclusions: When performing radial EBUS biopsy for PLLs, a multimodal biopsy approach (adding LFB or NA to TBLB) increases not only DY but also DTAR.
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