Background: Radial endobronchial ultrasound (R-EBUS), virtual bronchoscopic navigation (VBN), and electromagnetic navigation bronchoscopy (ENB) are widely used bronchoscopic techniques for diagnosing peripheral pulmonary lesions (PPLs). However, the applications of their combinations remain unclear.
Objectives: This study aimed to investigate the diagnostic performance and safety of R-EBUS versus its combination with ENB or VBN and lesion characteristics.
Design: This study is a retrospective, single-center cohort study.
Methods: Patients who underwent R-EBUS without and with ENB or VBN (R-EBUS+ENB, R-EBUS+VBN) for peripheral pulmonary. Diagnostic yield, sensitivity, specificity, and complications were compared using inverse probability of treatment weighting (IPTW) for baseline difference adjustment.
Results: R-EBUS, R-EBUS+ENB, and R-EBUS+VBN groups had diagnostic yields of 74.6%, 78.2%, and 73.0%, respectively (no significant differences after IPTW adjustment). Multimodal approaches significantly improved diagnostic yield in patients with emphysematous lungs (R-EBUS vs R-EBUS+ENB: odds ratio (OR): 3.51; 95% confidence interval (CI): 1.38-8.95; p = 0.009; R-EBUS vs R-EBUS+VBN: OR: 3.14; 95% CI: 1.05-9.35; p = 0.04). R-EBUS+ENB demonstrated superior diagnostic performance in lesions ⩽20 mm (OR: 3.58; 95% CI: 1.28-9.98; p = 0.015), lesions with positive bronchial signs (OR: 1.98; 95% CI: 1.07-3.67; p = 0.029), and solid lesions with combined positive bronchial signs (OR: 2.67; 95% CI: 1.18-6.07; p = 0.019). Mild bleeding was more frequent in the R-EBUS+ENB group than in the R-EBUS group (OR: 3.21; 95% CI: 1.13-9.13; p = 0.029); severe complications did not significantly differ among groups.
Conclusion: Comparable diagnostic performances were observed among R-EBUS, R-EBUS+ENB, and R-EBUS+VBN groups. Multimodal approaches significantly enhanced diagnostic accuracy in subtypes with lesions of small size, positive bronchial signs, or emphysematous lungs. These findings highlight the importance of tailored multimodal strategies to improve diagnostic yield and procedural safety in PPL evaluation.
Keywords: electromagnetic navigation bronchoscopy; endobronchial ultrasound; lung neoplasms; pulmonary medicine; virtual bronchoscopic navigation.
Comparing three bronchoscopy techniques to improve the diagnosis of lung nodulesWhy was the study done? Lung nodules are small spots in the lungs that may be signs of cancer or other conditions. Diagnosing them early and accurately is important for proper treatment. Doctors often use bronchoscopy—a procedure that uses a thin tube to collect tissue samples from the lungs. While several advanced techniques are available, it is unclear whether combining them improves diagnostic accuracy and safety. This study compared three common methods—radial endobronchial ultrasound (R-EBUS), R-EBUS with electromagnetic navigation bronchoscopy (ENB), and R-EBUS with virtual bronchoscopic navigation (VBN)—to see which worked best. What did the researchers do? The team reviewed data from 441 patients who underwent bronchoscopy between 2016 and 2024. Patients were grouped based on the method used: R-EBUS alone, R-EBUS+ENB, or R-EBUS+VBN. The researchers compared how well each method diagnosed lung nodules and examined any complications, such as bleeding or collapsed lung. What did the researchers find? All three methods had similar overall accuracy, with success rates between 73.0% and 78.2%. However, combined approaches offered better results in certain cases. Patients with emphysema had improved diagnostic outcomes when ENB or VBN was added to R-EBUS. The R-EBUS+ENB combination also performed better for small nodules (⩽20 mm) and those near the airways. Mild bleeding was slightly more common with ENB, but serious complications were rare across all groups. What do the findings mean? R-EBUS alone is effective for most patients, but combining it with ENB or VBN may improve diagnosis in specific situations—such as for patients with emphysema or small, hard-to-reach nodules. These results can help doctors choose the best diagnostic approach based on individual characteristics of the patient and lung lesion.