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Multimodality-guided Transbronchial Lung Biopsy in Peripheral Pulmonary Nodules: A Comparison Between using an Electromagnetic Navigation Bronchoscopy and a Thin Bronchoscope

Objective: To compare the diagnostic yield of using a thin bronchoscope (TB) and ENB in the diagnosis of small PPNs combined with routine R-EBUS and fluoroscopy.Materials and Methods: Patients with a PPN less than or equal to 30 mm were randomly assigned into 2 groups: 4 mm thin bronchoscope (TB group) and 5.9 mm conventional bronchoscope with an ENB (the superDimension®) system (ENB group).Results: In total, 49 patients were enrolled and randomized into two groups: TB group (n = 24) and ENB group (n = 25). The mean size of the PPNs was 22 mm. There was no difference in nodule size, location of the nodules, the presence of computed tomography (CT) bronchus sign, and EBUS location between the groups. The diagnostic yields were 73.9% and 66.7% in the TB group and ENB group, respectively. There was no statistically significant difference in the diagnostic yield between the two groups. Multivariate analysis showed that the diagnostic yieldwas significantly higher when there was also a CT bronchus sign (odds ratio 48.82, p = 0.031) and when the bronchoscope could reach a greater airway depth (odds ratio 6.21, p = 0.023). The overall complication was 2%, which was pneumothorax in one patient in the TB group.Conclusion: Multimodality-guided techniques can improve the diagnostic yield in the diagnosis of PPNs. The PPNs larger than 2 cm with the presence of CT bronchus sign, the ENB provides a similar diagnostic yield compared to the thin bronchoscope. Further analysis and adequately powered prospective studies are required to confirm the advantages of ENB.