IN a new multicenter trial, navigational bronchoscopy was found to be noninferior in diagnostic accuracy to transthoracic needle biopsy (TTNB) for evaluating peripheral pulmonary nodules, while significantly reducing the risk of procedural complications such as pneumothorax.
The randomized, parallel-group trial, conducted at seven U.S. centers, included patients with intermediate- or high-risk lung nodules measuring 10 to 30 mm. Participants were assigned to undergo either navigational bronchoscopy or CT-guided transthoracic needle biopsy. The primary endpoint was diagnostic accuracy, defined as a specific diagnosis (cancer or benign condition) confirmed with 12 months of clinical follow-up.
Among 234 patients included in the analysis, 79.0% of those in the navigational bronchoscopy group and 73.6% in the TTNB group received a diagnosis that remained consistent over the year-long follow-up. This 5.4 percentage point difference (95% CI, –6.5 to 17.2) met the criteria for noninferiority (P=0.003), although not for superiority (P=0.17).
The trial’s most notable clinical distinction came from its complication profile. Pneumothorax occurred in just 3.3% of patients who underwent navigational bronchoscopy, compared to 28.3% in the TTNB group. More serious outcomes, such as chest tube placement or hospital admission, were needed for only 0.8% of bronchoscopy patients, versus 11.5% of TTNB patients.
These results underscore navigational bronchoscopy as a viable and safer diagnostic alternative for patients with peripheral lung nodules. As lung cancer screening becomes more prevalent and the number of incidentally detected nodules continues to rise, this data may influence biopsy approach decisions, particularly for patients at higher risk of procedural complications.
With growing interest in minimally invasive pulmonary diagnostics, this study provides compelling evidence to support broader use of bronchoscopic techniques in routine clinical practice.
Reference:
Lentz RJ et al. Navigational Bronchoscopy or Transthoracic Needle Biopsy for Lung Nodules. N Engl J Med. 2025;392:2100-112.
