Background: Nonresolving or slowly resolving pneumonia (NRP) poses a diagnostic challenge because infectious and noninfectious etiologies often mimic community‐acquired pneumonia on imaging. Endobronchial ultrasound‐guided transbronchial lung biopsy (EBUS‐TBLB) improves tissue acquisition for peripheral lesions, whereas metagenomic next‐generation sequencing (mNGS) offers culture‐independent pathogen detection. Whether their combination enhances etiological clarification of NRP remains uncertain. Methods: A total of 109 consecutive adults with NRP unresponsive to standard antimicrobial therapy were randomized to EBUS‐TBLB alone ( n = 66) or EBUS‐TBLB + mNGS ( n = 43). Baseline characteristics, diagnostic yield, and procedure‐related complications were recorded. Diagnostic positivity, sensitivity for infectious agents, and safety profiles were compared using χ 2 or Fisher’s exact tests, with p 0.05). No severe adverse events occurred. Conclusions: EBUS‐TBLB + mNGS represents a paradigm shift in the diagnosis of complex respiratory cases, integrating imaging with advanced genomics to enhance precision medicine. In practice, early implementation of the EBUS‐TBLB + mNGS diagnostic protocol in patients with NRP can help exclude malignancy or confirm an infectious etiology.
Li et al. (Wed,) studied this question.