Radial EBUS versus CT-guided needle biopsy for evaluation of solitary pulmonary nodules.

Objective: This study is aimed to compare the diagnostic yield, complications and influencing factors between Radial endobroncheal ultrasonography guided bronchoscopy(R-EBUS) and CT-guided needle biopsy (CT-PNB), for evaluation of solitary pulmonary nodules(SPNs).

Matrials and Methods: 160 cases of consecutive patients with SPNs were enrolled and divided into R-EBUS and CT-PNB groups randomly. The diagnostic yield, complications and influencing factors between the two groups were evaluated.

Results: Sensitivity of R-EBUS for malignancy was 73.7% (42/57) and for benign, was 43.5% (10/23), overall diagnostic accuracy was 65% (52/80). In CT-PNB group, overall diagnostic accuracy was 85% (68/80), sensitivity for malignancy was 87.9% (51/58), and for benign was 81.0% (17/21), respectively. Both overall diagnostic yield and incidence of complications in CT-PNB group were higher than those in R-EBUS group ( P = 0.006, P = 0.002). In R-EBUS group, the factors affecting diagnostic yield were size ( P = 0.027), the distance between SPNs and pleura ( P = 0.031) and the location of the probe to lesions ( P = 0.009). In CT-PNB group, the distance from the lesions to pleura was correlated with the incidence of pneumothorax ( P = 0.001) and pulmonary haemorrhage ( P = 0.042). The location of SPNs were adjacent to great vessels was another influencing factor for pulmonary haemorrhage ( P = 0.042).

Conclusions: Both R-EBUS and CT-PNB are valuable tools for diagnosis. SPNs located in medial 1/2 of lung field, or were adjacent to great vessels may be fit for R-EBUS. Those SPNs located in lateral 1/2 of lung field, near to pleura or with less vessels around may be more suitable for CT-PNB.