Lung cancer · Sampling the pulmonary nodule
Navigational Bronchoscopy or Transthoracic Needle Biopsy for Lung Nodules
| Design | Randomised equivalence trial |
|---|---|
| Treatment | Navigational bronchoscopy |
| Control | Transthoracic needle biopsy |
| Population | 234 patients with peripheral pulmonary nodules measuring 10 to 30 mm |
| Follow-up | 12 months |
| Primary endpoint | Diagnostic accuracy, confirmed through month 12 |
| Result | A specific, accurate diagnosis was obtained in 94 of 119 (79.0%) with navigational bronchoscopy, non-inferior to transthoracic needle biopsy (p=0.003 for non-inferiority, p=0.17 for superiority). Pneumothorax occurred in 4 of 121 (3.3%) versus 32 of 113 (28.3%), requiring a chest drain or admission in 0.8% versus 11.5%. |
| Secondary endpoints | Pneumothorax, chest tube placement, hospital admission |
The diagnostic accuracy of navigational bronchoscopy was noninferior to that of transthoracic needle biopsy among patients with peripheral pulmonary nodules measuring 10 to 30 mm.
The trial authors, in the published abstract
The accuracy result is non-inferiority; the reason to change practice is the complication rate — 3.3% pneumothorax against 28.3%. As screening (NELSON, NLST) generates more nodules needing tissue, the safer route to a diagnosis matters more.
Lentz RJ, Frederick-Dyer K, Planz VB, et al. Navigational Bronchoscopy or Transthoracic Needle Biopsy for Lung Nodules. N Engl J Med 2025 Jun 5;392(21):2100-2112.