July 2025

PULMONARY

NAVIGATIONAL BRONCHOSCOPY OR TRANSTHORACIC NEEDLE BIOPSY FOR LUNG NODULES


​Featuring: Momen M. Wahidi, MD
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​A recently published study in the New England Journal of Medicine by a group of scientists including Momen M. Wahidi, MD, addresses a critical issue in lung health: the optimal method for diagnosing peripheral pulmonary nodules, often found incidentally or during lung cancer screenings. With millions of such nodules identified each year, distinguishing between benign conditions and cancer is essential for guiding patient care.

The study compared two common biopsy techniques to evaluate their diagnostic accuracy in intermediate- and high-risk patients:
  • Navigational bronchoscopy
  • CT-guided transthoracic needle biopsy

Conducted across seven centers in the U.S., the trial assigned 234 patients with nodules measuring 10 to 30 millimeters to one of the two biopsy procedures.

Study Findings
Results showed that navigational bronchoscopy yielded a diagnostic accuracy of 79%, while transthoracic needle biopsy demonstrated a slightly lower accuracy at 73.6%. Importantly, the study confirmed the noninferiority of navigational bronchoscopy in accurately diagnosing lung nodules.

Another critical finding was related to procedural complications. Pneumothorax, a potential risk of these procedures, occurred in just 3.3% of patients undergoing navigational bronchoscopy, compared to a significantly higher rate of 28.3% in those who had a transthoracic needle biopsy. This highlights the potential benefits of navigational bronchoscopy not just in diagnostics but also in procedural safety.
​
Takeaways
The study suggests that navigational bronchoscopy is a viable and effective alternative to transthoracic needle biopsy for the diagnosis of peripheral pulmonary nodules, combining favorable diagnostic outcomes with a lower risk of complications. This research offers valuable insights for navigating the complexities of lung nodule evaluation.​
Momen M. Wahidi, MD, Professor of Pulmonary and Critical Care at Northwestern Medicine

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