Evaluation of the efficacy of different lung biopsy modalities in solitary pulmonary nodules

Introduction This study compared the diagnostic performance and safety of computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) and virtual bronchoscopic navigation (VBN)-guided transbronchial lung biopsy (TBLB) in patients with solitary pulmonary nodules (SPNs). Methods A retrospective analysis was conducted on 204 SPN patients, divided into CT-guided (n = 102) and VBN-guided (n = 102) groups. Parameters, including diagnostic yield, procedure time, and complication rates, were compared between the two methods. Results After applying rigorous diagnostic criteria per ATS/ACCP guidelines, the overall diagnostic yield was higher in the VBN group (64.7%, 66/102) than in the CT group (59.8%, 61/102), though the difference was not statistically significant (P = 0.472). In exploratory subgroup analyses, VBN demonstrated higher diagnostic yield for smaller nodules (8–20 mm) and those located closer to the pleura (2–3 cm) (both P < 0.05). For larger nodules (20–30 mm) or those further from the pleura (3–5 cm), diagnostic rates were comparable between groups. The VBN group had significantly shorter procedure times, including lesion localization (6.62 ± 0.93 vs. 9.27 ± 1.05 min) and total procedure duration (22.04 ± 2.36 vs. 38.16 ± 4.29 min) (P < 0.01). The complication rate was significantly lower in the VBN group (9.80% vs. 29.41%, P < 0.01), with the CT group showing higher incidences of pneumothorax, hemoptysis, and chest pain in nodules 2-3 cm from the pleura. Multivariate analysis identified several factors significantly associated with diagnostic outcomes. Additionally, the VBN group incurred lower medical costs and shorter hospital stays (P < 0.01). Conclusion VBN-guided biopsy was associated with higher diagnostic yield, fewer complications, shorter procedure times, and lower costs compared to CT-guided biopsy. These findings warrant confirmation in prospective randomized trials.