Cone Beam Computed Tomography-Guided Bronchoscopy versus Computed Tomography-Guided Transthoracic Needle Biopsy for Peripheral Pulmonary Lesion Diagnosis.
[BACKGROUND] The identification of peripheral pulmonary lesions (PPLs) has increased significantly, either incidentally or through lung cancer screening, necessitating more biopsies to differentiate b
- p-value p<0.001
- 95% CI 0.939-1.020
- 연구 설계 cohort study
APA
Patel P, Ost DE, et al. (2026). Cone Beam Computed Tomography-Guided Bronchoscopy versus Computed Tomography-Guided Transthoracic Needle Biopsy for Peripheral Pulmonary Lesion Diagnosis.. Chest. https://doi.org/10.1016/j.chest.2026.02.038
MLA
Patel P, et al.. "Cone Beam Computed Tomography-Guided Bronchoscopy versus Computed Tomography-Guided Transthoracic Needle Biopsy for Peripheral Pulmonary Lesion Diagnosis.." Chest, 2026.
PMID
41895580
Abstract
[BACKGROUND] The 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 etiologies. Cone beam computed tomography-guided bronchoscopic biopsy (CBCT-GB) and computed tomography-guided transthoracic needle biopsy (CT-TTNB) are commonly used for these biopsies, but their comparative diagnostic abilities have not been studied.
[RESEARCH QUESTION] How does CBCT-GB compare to CT-TTNB for diagnosing PPLs?
[STUDY DESIGN AND METHODS] This 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 24-month follow-up, defined as the proportion of cases yielding a specific diagnosis (malignant or non-malignant) or a non-specific 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.
[RESULTS] Out of 895 patients analyzed, 340 of 375 (90.7%) in the CBCT-GB group and 440 of 475 (92.6%) in the CT-TTNB group had a diagnostic result (p=0.301, Odds Ratio 0.979, 95% CI: 0.939-1.020). Complications occurred in 4.3% of CBCT-GB patients and 41.6% of CT-TTNB patients (p<0.001). Pneumothorax rates were 1.8% for CBCT-GB and 31.4% for CT-TTNB (p<0.001), while severe bleeding or cardiorespiratory failure occurred in 3.3% and 6.0% of patients respectively (p<0.001). Among patients meeting criteria for upfront invasive mediastinal staging, 86.5% of CBCT-GB patients received it at the time of PPL biopsy, compared to 14.0% after biopsy in the CT-TTNB group (p<0.001). Median effective radiation dose was 8.6 millisieverts in the robotic bronchoscopy CBCT-GB group and 7.5 millisieverts in the CT-TTNB group (p=0.074).
[INTERPRETATION] CBCT-GB demonstrated a 24-month diagnostic accuracy comparable to CT-TTNB while offering improved safety and concurrent mediastinal lymph node staging. This data supports CBCT-GB as the optimal initial procedure for PPL diagnosis.
[RESEARCH QUESTION] How does CBCT-GB compare to CT-TTNB for diagnosing PPLs?
[STUDY DESIGN AND METHODS] This 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 24-month follow-up, defined as the proportion of cases yielding a specific diagnosis (malignant or non-malignant) or a non-specific 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.
[RESULTS] Out of 895 patients analyzed, 340 of 375 (90.7%) in the CBCT-GB group and 440 of 475 (92.6%) in the CT-TTNB group had a diagnostic result (p=0.301, Odds Ratio 0.979, 95% CI: 0.939-1.020). Complications occurred in 4.3% of CBCT-GB patients and 41.6% of CT-TTNB patients (p<0.001). Pneumothorax rates were 1.8% for CBCT-GB and 31.4% for CT-TTNB (p<0.001), while severe bleeding or cardiorespiratory failure occurred in 3.3% and 6.0% of patients respectively (p<0.001). Among patients meeting criteria for upfront invasive mediastinal staging, 86.5% of CBCT-GB patients received it at the time of PPL biopsy, compared to 14.0% after biopsy in the CT-TTNB group (p<0.001). Median effective radiation dose was 8.6 millisieverts in the robotic bronchoscopy CBCT-GB group and 7.5 millisieverts in the CT-TTNB group (p=0.074).
[INTERPRETATION] CBCT-GB demonstrated a 24-month diagnostic accuracy comparable to CT-TTNB while offering improved safety and concurrent mediastinal lymph node staging. This data supports CBCT-GB as the optimal initial procedure for PPL diagnosis.