title: Comparative effectiveness of radial probe endobronchial ultrasound versus CT-guided needle biopsy for evaluation of peripheral pulmonary lesions: a randomized pragmatic trial.
abstract: In many patients the optimal method of investigation of peripheral pulmonary lesions (PPL) is not clear. We performed a prospective randomized pragmatic trial to determine the comparative effectiveness of endobronchial ultrasound-guided transbronchial lung biopsy (EBUS-TBLB) and CT-guided percutaneous needle biopsy (CT-PNB) for the investigation of PPL. Overall complication rates were higher in those undergoing CT-PNB (27% v 3%, p = 0.03), while diagnostic accuracy of EBUS-TBLB was shown to be non-inferior to that of CT-PNB. Expected diagnostic accuracy and complication rates are likely to differ for individual patients on the basis of specific complex clinicoradiologic factors, which will influence the cost-benefit analysis between EBUS-TBLB and CT-PNB for individual patients. Further studies are required to examine the effect of these factors on clinical decision-making.
authors.affiliation: Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville 3050, Australia. daniel.steinfort@mh.org.au
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Steinfort
authors.forename: Janette
authors.initials: J
authors.lastname: Vincent
authors.forename: Stefan
authors.initials: S
authors.lastname: Heinze
authors.forename: Phillip
authors.initials: P
authors.lastname: Antippa
authors.forename: Louis B
authors.initials: LB
authors.lastname: Irving
mesh_terms: D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000000981:diagnostic imaging / Q000473:pathology*; D000368:Aged; D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods; D001999:Bronchoscopy / Q000295:instrumentation; D003657:Decision Making; D019160:Endosonography / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D018307:Neoplasms, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed